Malnutrition in cirrhosis increases morbidity and mortality

Maharshi, Sudhir; Sharma, Barjesh Chander; Srivastava, Siddharth

doi:10.1111/jgh.12999

Cited by 144 publications

(134 citation statements)

References 26 publications

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“…Physical activity increases skeletal muscle mass and functional capacity[24–26,44,45]. Given subjective fatigue and decreased muscle strength, it is not clear if it is possible to increase muscle mass by resistance exercise and endurance exercise improves functional capacity but may not have an impact on skeletal muscle mass.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

“…Treatment approaches to date have focused on replacing calories and proteins by different routes of administration with little benefit[22,23]. Exercise and physical activity may be beneficial but are limited by fatigue[24–26]. Molecular approaches using direct activation of protein synthesis by L-leucine have shown benefit at least in the acute setting[19].…”

Section: Introductionmentioning

confidence: 99%

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Cause and management of muscle wasting in chronic liver disease

Dasarathy

2016

Current Opinion in Gastroenterology

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Purpose of review Sarcopenia or loss of skeletal muscle loss is the major component of malnutrition and occurs in the majority of patients with liver disease. Lower muscle contractile function also contributes to the adverse consequences of sarcopenia. There are no effective therapies to prevent or reverse sarcopenia in liver disease. This review will discuss the advances in diagnosis, pathogenesis and treatment options for sarcopenia in liver disease. Recent findings Sarcopenia increases mortality, risk of development of other complications of cirrhosis, and post liver transplant outcomes while quality of life is decreased. Unlike other complications of cirrhosis that reverse after liver transplantation, sarcopenia may not improve and actually worsens. Impaired skeletal muscle protein synthesis and increased proteolysis via autophagy contribute to sarcopenia. Hyperammonemia is the best-studied mediator of the liver-muscle axis. Molecular studies show increased expression of myostatin while metabolic studies show impaired mitochondrial function and tricarboxylic acid cycle intermediates due to cataplerosis of α-ketoglutarate. Impaired skeletal muscle pyruvate and fatty acid oxidation during hyperammonemia suggest amino acids are diverted to acetyl CoA and potentially aggravate hyperammonemia. Nutritional supplementation is of limited or no benefit and suggests that cirrhosis is a state of anabolic resistance. Exercise maybe beneficial but whether it overcomes anabolic resistance is not known. Summary The high clinical significance of sarcopenia is well established. Current approaches to nutritional supplementation have not been effective in reversing sarcopenia because of anabolic resistance. Myostatin antagonists, specific amino acid supplementation, mitochondrial protection and combination endurance-resistance exercise are potential future therapeutic options.

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Section: Therapeutic Optionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cause and management of muscle wasting in chronic liver disease

Dasarathy

2016

Current Opinion in Gastroenterology

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“…Cirrhosis can lead to complications such as impaired immune function and infection, coagulopathy, renal failure, neurologic dysfunction, and malnutrition[1,3–6]. Ten percent of patients with decompensated cirrhosis require surgical procedures[7] and these patients are at a significantly higher risk for developing surgical complications[8–10].…”

Section: Introductionmentioning

confidence: 99%

Impact of Cirrhosis on Resource Use and Inpatient Complications in Patients Undergoing Total Knee and Hip Arthroplasty

Newman

Schiltz

Mudd

et al. 2016

The Journal of Arthroplasty

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Background Cirrhosis is a major cause of morbidity and mortality and is an important risk factor for complications in surgical patients. The purpose of this study was to investigate the association of cirrhosis with postoperative complications, length of stay (LOS), and costs among patients who underwent total knee (TKA) or hip (THA) arthroplasty. Methods Using the Nationwide Inpatient Sample between 2000 and 2011, we identified patients who had a primary TKA or primary THA. TKA patients were divided into two groups: 1) cirrhosis (n= 41,464) and 2) no cirrhosis (n= 5,721,297) and THA patients were divided into two groups: 1) cirrhosis (n= 27,401) and 2) no cirrhosis (n= 2,622,539). Patient demographics, comorbidities, perioperative complications, LOS, incremental costs were analyzed. An additional subgroup analysis by cirrhosis etiology was performed. Results Multivariable analysis revealed cirrhosis was associated with 1.55 (95%CI: 1.47–1.63) times higher odds of any complication after TKA, and 1.59 (1.50–1.69) higher odds after THA. Adjusted outcomes showed cirrhotic TKA patients had $1,857 higher costs and 0.30 days longer LOS, and THA cirrhotic patients had $1,497 higher costs and 0.48 longer LOS. We found similar results for each cirrhosis subtype, but alcohol-related had the highest resource use and complication rate. Conclusion Patients with cirrhosis who are undergoing TKA or THA are at a significantly increased risk for perioperative complications, increased LOS and higher costs. The perioperative complications and costs were highest among patients with alcohol-related cirrhosis.

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“…Poor nutritional status has an adverse effect on prognosis. [56][57][58] Alcohol impairs the intestinal absorption and hepatic storage of thiamine, and heavy drinkers are often deficient. Parenteral thiamine can reduce the risk of alcohol related brain damage, Wernicke's encephalopathy, and Korsakoff's syndrome.…”

Section: Managing Nutrition In Decompensated Arldmentioning

confidence: 99%