Randomized Pilot Study: Effects of an Exercise Programme and Leucine Supplementation in Patients with Cirrhosis

Román, Eva; Torrades, M. T.; Nadal, Maria Josep; Cárdenas, Guillem; Nieto, Juan C.; Vidal, Sílvia; Ambrós, H. Bascuñana; Júarez, Cándido; Guarner, Carlos; Córdoba, Juan; Soriano, Germán

doi:10.1007/s10620-014-3086-6

Cited by 171 publications

(194 citation statements)

References 51 publications

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“…However, 2 metaanalyses have suggested that supplemental nutrition does not improve nutritional our clinical outcomes[22,23]. This is because patients with liver disease are believed to be in a state of anabolic resistance that prevents appropriate skeletal muscle responses to nutrient administration[37]. Skeletal muscle mass is maintained by a balance between protein synthesis, breakdown and possibly the regenerative potential mediated by the myogenically committed stem cells, satellite cells[1].…”

Section: Mechanisms Of Sarcopenia In Cirrhosismentioning

confidence: 99%

“…To overcome anabolic resistance, a strategy that has been beneficial is to shorten the postabsorptive or fasting state. Overnight fasting provides the greatest window of anabolic opportunity but frequent overnight feeding is difficult, causes sleep disturbances and has the potential for aggravating both reflux and insulin resistance[37]. To overcome these limitations by avoiding fasting induced proteolysis and lipolysis, frequent feeding and late evening snacks have been used with some benefit.…”

Section: Therapeutic Optionsmentioning

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: Mechanisms Of Sarcopenia In Cirrhosismentioning

confidence: 99%

Section: Therapeutic Optionsmentioning

confidence: 99%

Cause and management of muscle wasting in chronic liver disease

Dasarathy

2016

Current Opinion in Gastroenterology

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“…62 A pilot study revealed improvement in a 6-minute walk test in those who combined daily leucine supplementations with hour-long treadmill and cycle exercise 3 times a week with to achieve 60% to 70% maximum heart rate. 89 In this randomized pilot study, 17 patients with cirrhosis were randomized to a treatment arm consisting of 12 weeks of exercise, or control. At the 24-week follow-up, patients who exercised had a significant increase in thigh muscle circumference and in overall weight.…”

Section: Management Of Frailty and Sarcopenia In Patients With Cirrhomentioning

confidence: 99%

The Role of Sarcopenia and Frailty in Hepatic Encephalopathy Management

Lucero¹,

Verna²

2015

Clinics in Liver Disease

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“…The intervention group had improvement in 2-min step test, increased thigh circumference, and improved quality of life compared to no interval change in the control group. No adverse events were seen in the intervention group [70]. Additionally, several studies have demonstrated that formalized exercise regimen will improve insulin sensitivity among patients with liver disease, which is particularly important among patients with sarcopenic obesity [71][72][73].…”

Section: Exercise and Preservation Of Muscle Massmentioning

confidence: 86%

Sarcopenia in Patients with Chronic Liver Disease: Can It Be Altered by Diet and Exercise?

Kappus

Mendoza

Nguyen

et al. 2016

Curr Gastroenterol Rep

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Sarcopenia, a loss of muscle mass, is being increasingly recognized to have a deleterious effect on outcomes in patients with chronic liver disease. Factors related to diet and the inflammatory nature of chronic liver disease contribute to the occurrence of sarcopenia in these patients. Sarcopenia adversely influences quality of life, performance, morbidity, success of transplantation, and even mortality. Specific deficiencies in macronutrients (protein, polyunsaturated fatty acids) and micronutrients (vitamins C, D, and E, carotenoids, and selenium) have been linked to sarcopenia. Lessons learned from nutritional therapy in geriatric patient populations may provide strategies to manage sarcopenia in patients with liver disease. Combining diet modification and nutrient supplementation with an organized program of exercise may help ameliorate or even reverse the effects of sarcopenia on an already complex disease process.

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Randomized Pilot Study: Effects of an Exercise Programme and Leucine Supplementation in Patients with Cirrhosis

Abstract: A programme of moderate physical exercise together with leucine supplements in patients with cirrhosis is safe and improves exercise capacity, leg muscle mass and HRQoL.

Cited by 171 publications

References 51 publications

Cause and management of muscle wasting in chronic liver disease

Cause and management of muscle wasting in chronic liver disease

The Role of Sarcopenia and Frailty in Hepatic Encephalopathy Management

Sarcopenia in Patients with Chronic Liver Disease: Can It Be Altered by Diet and Exercise?

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