Sarcopenia in chronic advanced liver diseases: A sex-oriented analysis of the literature

Guarino, Maria; Cossiga, Valentina; Becchetti, Chiara; Invernizzi, Federica; Lavezzo, Bruna; Lenci, Ilaria; Merli, Manuela; Pasulo, L.; Zanetto, Alberto; Burra, Patrizia; Morisco, Filomena

doi:10.1016/j.dld.2021.10.010

Cited by 10 publications

(7 citation statements)

References 72 publications

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“…Since the submission of this review for publication, calls for more comprehensive research in this field have been echoed in a new addition to the literature. 13 …”

Section: Discussionmentioning

confidence: 99%

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The sex‐specific prognostic utility of sarcopenia in cirrhosis

Lowe

Hey

Sinclair

2022

J cachexia sarcopenia muscle

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Sarcopenia is an increasingly recognized complication of cirrhosis that is associated with morbidity and mortality. Differences in the prevalence and prognosis of sarcopenia between men and women have been reported in other patient groups, but there is insufficient understanding of how sex impacts the prognostic value of sarcopenia in cirrhosis. A search of MEDLINE and Embase was conducted from earliest entries to April 2021. Studies were included if they examined sex‐stratified mortality impact of reduced muscle function or mass in outpatient populations with cirrhosis. We identified 700 studies of which 6 were deemed relevant for inclusion in this narrative review. Studies of interest were heterogeneous, precluding pooling of data and making interpretation of the literature challenging. Muscle mass was assessed in five studies (n = 2566, 1730 men, 836 women) and was reduced in 36–50% of men and 24–43% of women. All five studies found that reduced muscle mass determined by computed tomography, dual‐energy X‐ray absorptiometry, and bioelectrical impedance analysis was associated with increased mortality in men. Of these, two studies identified a corresponding relationship in women; reduced muscle mass defined by computed tomography was associated with increased mortality [hazard ratio (HR) 2.82, P = 0.001], while increasing muscle mass by bioelectrical impedance analysis likewise conferred a survival benefit (HR 0.45, P = 0.0016). Only one study assessed the relationship of muscle function with sex‐stratified mortality (n = 1405, 827 men, 578 women), concluding that reduced muscle function predicted mortality in both men and women (HR 1.65, P < 0.001 and HR 1.54, P < 0.001, respectively). Reduced muscle mass in cirrhosis is consistently associated with mortality in men, but lack of sex‐stratification of mortality analyses limits the ability to make strong conclusions about the impact of sarcopenia specifically in women, with even fewer data available for analysing muscle function. Improved understanding of the sex‐specific impacts of sarcopenia may help address patient deterioration and mortality while awaiting liver transplantation and allow for early intervention to mitigate mortality risk. Large, multicentre studies with adequate female participation and sex‐stratified mortality analyses are warranted.

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“…Since the submission of this review for publication, calls for more comprehensive research in this field have been echoed in a new addition to the literature. 13 …”

Section: Discussionmentioning

confidence: 99%

“…It reflects a lost opportunity to tease out this complex issue and means that it is not currently possible to make strong conclusion about the impact of sarcopenia in women. Since the submission of this review for publication, calls for more comprehensive research in this field have been echoed in a new addition to the literature 13 …”

Section: Discussionmentioning

confidence: 99%

The sex‐specific prognostic utility of sarcopenia in cirrhosis

Lowe

Hey

Sinclair

2022

J cachexia sarcopenia muscle

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“…Initially considered a disease confined to the elderly, several conditions are now known to considerably enhance sarcopenia risk, including states of prolonged physical inactivity, nutritional conditions that both limit oral calories and protein and/or reduce absorption of these nutrients, dysregulated insulin pathways, androgen deprivation states, wasting liver and kidney diseases, and malignancy [ 15 , 16 ]. Studies have shown that sarcopenia in advanced liver disease is associated with an increase in all-cause mortality and worse outcomes after liver transplantation, signaling a continued active area of research and an opportunity for improved management [ 17 , 18 ].…”

Section: Sarcopeniamentioning

confidence: 99%

“…Considering the deleterious effects of insulin resistance and metabolic syndrome on body composition coupled with enhanced rates of muscle breakdown in patients with advanced liver disease, patients with MASLD are at high risk of sarcopenia, especially as the disease progresses [ 15 , 16 , 17 , 18 ].…”

Section: Sarcopeniamentioning

confidence: 99%

“…MASLD is defined by the dysregulation of metabolic pathways, which may be implicated in the enhancement of sarcopenia [ 19 ] ( Figure 1 ). These mechanisms of disease that tie MASLD to loss of lean muscle mass include insulin resistance, lipogenesis, chronic inflammation, physical inactivity, and vitamin D deficiency [ 15 , 16 , 17 , 18 , 19 ].…”

Section: Pathophysiological Considerations Of Sarcopenia In Masldmentioning

confidence: 99%

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Implications of Protein and Sarcopenia in the Prognosis, Treatment, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Singh,

Buckholz,

Kumar

et al. 2024

Nutrients

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Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common cause of chronic liver disease globally, with prevalence rapidly increasing in parallel with rising rates of obesity and metabolic syndrome. MASLD is defined by the presence of excess fat in the liver, which may induce inflammatory changes and subsequent fibrosis in high-risk patients. Though MASLD occurs frequently, there is still no approved pharmacological treatment, and the mainstay of therapy remains lifestyle modification via dietary changes, enhancement of physical activity, and management of metabolic comorbidities. Most nutrition research and clinical guidance in this disease centers on the reduction in fructose and saturated fat in the diet, although the emerging literature suggests that protein supplementation is important and implicates muscle mass and sarcopenia in disease-related outcomes. This review will assess the current data on these topics, with the goal of defining best practices and identifying research gaps in care.

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