Resistance Training Increases Muscle Strength and Muscle Size in Patients With Liver Cirrhosis

Aamann, Luise; Dam, Gitte; Borre, Mette; Drljevic-Nielsen, Aska; Overgaard, Kristian; Andersen, Henning; Vilstrup, Hendrik; Aagaard, Niels Kristian

doi:10.1016/j.cgh.2019.07.058

Cited by 75 publications

(102 citation statements)

References 39 publications

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“…First, although PS matching and IPTW analyses can compensate for the lack of randomization and reduce bias and measured confounders [12], residual bias and unmeasured confounders may still exist. Furthermore, the retrospective nature of our study limits the assessment of variables including dietary intake, daily physical activity or exercise, and weight change, all of which may affect outcomes in patients with chronic liver disease [3,6,27]. It, therefore, follows from this point that a RCT is optimal to determine an effect of intervention on outcomes [12].…”

Section: Discussionmentioning

confidence: 99%

“…This poor nutritional status or nutritional deficiencies is associated with the development, severity, and increased rates of complications including infections, hepatic encephalopathy (HE), ascites, and sarcopenia, all of which impair the prognosis of patients with cirrhosis [1][2][3][4][5]. Reduced dietary intake contributes to malnutrition in patients with cirrhosis [6]. Insufficient dietary intake increases the risk of morbidity and mortality, whereas sufficient dietary intake can improve clinical outcomes [7].…”

Section: Introductionmentioning

confidence: 99%

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Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Hanai

Shiraki

Imai

et al. 2020

JCM

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The clinical efficacy of a late evening snack (LES) is well documented in patients with cirrhosis, but its effect on survival remains unclear. This cohort study aimed to compare the overall survival between LES-treated patients and untreated patients. We conducted a retrospective cohort study to determine the effect of LES, which is defined as an oral intake of a branched-chain amino acids (BCAA)-enriched nutrient before bedtime, on survival in 523 patients with cirrhosis seen at a tertiary referral center in Japan from March 2004 to April 2019. The association between LES and all-cause mortality was evaluated using propensity score matching and inverse probability of treatment weighting analyses. The median age of the 523 participants was 66 years; 286 (55%) patients were men and 87 (17%) received LES therapy. Of the 231 propensity-matched patients, 20 (26%) LES-treated patients and 72 (47%) untreated patients died during a median follow-up of 2.0 years (interquartile range, 0.5–4.8). Propensity score matching analysis showed that the overall survival was significantly higher in LES-treated patients than in untreated patients (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.93). The survival benefit of LES therapy was most prominent in patients with Child–Pugh C cirrhosis (HR, 0.40; 95% CI, 0.20–0.81). Inverse probability of treatment weighting analysis also revealed that LES significantly improved the prognosis of patients with cirrhosis (HR, 0.57; 95% CI, 0.33–0.99). In this retrospective study of patients with cirrhosis, we found that nocturnal BCAA supplementation was associated with a significant reduction in the risk of death in patients with liver cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Hanai

Shiraki

Imai

et al. 2020

JCM

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“…Exercise, including resistance training, might be a particularly attractive nonpharmacologic strategy for pain control given that it improves muscle mass and combats sarcopenia, which is associated with the development of HE and poor outcomes in those with cirrhosis. 4,[24][25][26][27][28] Topical therapies like capsaicin and low-dose acetaminophen (≤2 g/ F I G U R E 2 Flow diagram of cirrhosis patients including in our analysis cohort. The cohort included patients with at least two ICD-9 codes for cirrhosis with sufficient insurance/pharmacy coverage, a 12-mo look-back, no decompensation events during the look-back and no episodes of HE during the 6 mo after cirrhosis index date.…”

Section: Implications Of These Findingsmentioning

confidence: 99%

Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis

Moon

Jiang

Rogal

et al. 2020

Aliment Pharmacol Ther

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Summary Background Opioids are often prescribed for pain in cirrhosis and may increase the risk of hepatic encephalopathy (HE). Aim To assess the association between opioids and HE in patients with well‐compensated cirrhosis. Methods We used the IQVIA PharMetrics (Durham, NC) database to identify patients aged 18‐64 years with cirrhosis. We excluded patients with any decompensation event from 1 year before cirrhosis diagnosis to 6 months after cirrhosis diagnosis. Over the 6 months after cirrhosis diagnosis, we determined the duration of continuous opioid use and classified use into short term (1‐89 days) and chronic (90‐180 days). We assessed whether patients developed HE over the subsequent year (ie 6‐18 months after cirrhosis diagnosis). We used a landmark analysis and performed multivariable Cox proportional hazards regression to assess associations between opioid use and HE, adjusting for relevant confounders. Results The cohort included 6451 patients with compensated cirrhosis, of whom 23.3% and 4.7% had short‐term and chronic opioid prescriptions respectively. Over the subsequent year, HE occurred in 6.3% patients with chronic opioid prescriptions, 5.0% with short‐term opioid prescriptions and 3.3% with no opioid prescriptions. In the multivariable model, an increased risk of HE was observed with short‐term (adjusted hazard ratio, HR 1.44, 95% CI 1.07‐1.94) and chronic opioid prescriptions (adjusted HR 1.83, 95% CI 1.07‐3.12) compared to no opioid prescriptions. Conclusion In this national cohort of privately insured patients with cirrhosis, opioid prescriptions were associated with the risk of incident HE. Opioid use should be minimised in those with cirrhosis and, when required, limited to short duration.

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“…They found no difference in ammonia clearance between exercisers and controls. (1) Likewise, Roman et al also found no changes in blood ammonia levels after 12 weeks of aerobic exercise. (2) The study by Macias-Rodriguez et al measured ammonia before CPET, at termination, and then in 2-hour increments, both at baseline and after a 14-week exercise program.…”

Section: Discussionmentioning

confidence: 97%

Exercise‐Induced Hyperammonemia Does Not Precipitate Overt Hepatic Encephalopathy

et al. 2020

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Resistance Training Increases Muscle Strength and Muscle Size in Patients With Liver Cirrhosis

Cited by 75 publications

References 39 publications

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis

Exercise‐Induced Hyperammonemia Does Not Precipitate Overt Hepatic Encephalopathy

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