Sarcopenia and Frailty in Liver Cirrhosis

Abstract

Skeletal muscle is the largest organ in the body, and skeletal muscle atrophy results from a shift in the balance of protein synthesis and degradation toward protein breakdown. Primary sarcopenia is defined as a loss of skeletal muscle mass and strength or physical function due to aging, and secondary sarcopenia is defined as a loss of skeletal muscle mass and strength or physical function due to underlying diseases. Liver cirrhosis (LC) is one of the representative diseases which can be complicated with secondary sarcopenia. Muscle mass loss becomes more pronounced with worsening liver reserve in LC patients. While frailty encompasses a state of increased vulnerability to environmental factors, there is also the reversibility of returning to a healthy state with appropriate intervention. Several assessment criteria for sarcopenia and frailty were proposed in recent years. In 2016, the Japan Society of Hepatology created assessment criteria for sarcopenia in liver disease. In Japan, health checkups for frailty in the elderly aged 75 years or more started in April 2020. Both sarcopenia and frailty can be adverse predictors for cirrhotic patients. In this review article, we will summarize the current knowledge of sarcopenia and frailty in LC patients.

Frequency and Characteristics of Overestimated Renal Function in Japanese Patients with Chronic Liver Disease and Its Relation to Sarcopenia

“…Primary sarcopenia, defined as age-related skeletal muscle mass atrophy and loss of muscle strength, has a poor prognosis [ 6 , 7 , 8 ]. CLD is a well-known cause of secondary sarcopenia [ 8 , 9 ]. The Japan Society of Hepatology (JSH) guidelines [ 10 ] recommend the diagnosis of sarcopenia in liver disease by measuring muscle strength and skeletal muscle mass.…”

Prediction of Patient Survival with Psoas Muscle Density Following Transjugular Intrahepatic Portosystemic Shunts: A Retrospective Cohort Study

“…In our study, PMD decreased with aging, and it differed by sex ( Table 3 ). Levels of serum zinc, serum vitamin D, blood ammonia, and testosterone may cause variation in the muscle between individuals of different ages and sex [ 1 ]. Our study of 273 patients who underwent TIPS showed that MELD outperformed MELD-Na in predicting 1-year mortality.…”

“…Sarcopenia is characterized as the generalized loss of skeletal muscle mass, strength, and physical function [ 1 ]. The major component of malnutrition in liver disease is the loss of skeletal muscle mass or sarcopenia [ 2 ].…”

“…The complication rate of sarcopenia in patients with liver cirrhosis (LC) was reported to be 30–70% [ 3 , 4 ], and in patients with end-stage liver disease, the proportion is 40–60% [ 5 – 7 ]. A variety of measurements have been applied to assess the nutritional status of patients with LC [ 1 , 8 ]. Although a number of studies have measured the psoas muscle cross-sectional area (PMA) at the L3 vertebra level by computed tomography (CT) to quantify nutritional status [ 9 , 10 ], it may not be comprehensive because the PMA measurements did not include muscle mass or fat infiltration.…”

Influencing Factors and Molecular Pathogenesis of Sarcopenia and Osteosarcopenia in Chronic Liver Disease

“…As an initial screening for sarcopenia, the AWGS 2019 also recommends SARC-F and calf circumference measurement (cutoff values: <34 and <33 cm for men and women, respectively). Meanwhile, the JSH proposed simple and practical sarcopenia criteria for patients with CLD in 2016 [ 5 ], with the following characteristics: (1) omission of age restriction given that secondary sarcopenia in CLD is associated with nutritional and hormonal impairment as well as inflammatory cytokines rather than aging itself, (2) omission of gait speed assessment due to its complexity, and (3) the establishment of reference values for muscle mass using computed tomography (CT) given that patients with CLD undergo regular CT examinations [ 25 ]. Using CT, the skeletal muscle mass index (SMI) is calculated as the sum of muscle mass at the L3 level divided by the height squared, which is strongly correlated with SMI measured using the bioelectrical impedance analysis method [ 5 ].…”