Effects of exercise and nutrition in improving sarcopenia in liver cirrhosis patients: a systematic review and meta-analysis

Background: Sarcopenia is highly prevalent in patients with liver cirrhosis (LC), adversely affecting their quality of life and life expectancy. Exercise and nutrition represent common interventions to ameliorate sarcopenia in these patients, although there exists inconsistency in the reported effectiveness of these strategies. This study seeks to assess the impact of exercise and nutrition on sarcopenia in LC patients through a systematic review and metaanalysis. Methods: The research protocol was preregistered on PROSPERO, and adherence to PRISMA reporting guidelines was maintained throughout the systematic review process. Controlled vocabularies via Emtree, MeSH, and CINAHL Subject Heading were searched in five databases without any language limitation. The final analysis included only studies with a randomized controlled trial (RCT) design published by December 2021. The quality of these studies was assessed by the Cochrane ROB 2.0 version, and the meta-analysis was conducted using Review Manager 5.4 version. Results: A total of 262 studies were screened, and seven RCT studies involving 206 subjects were included in the meta-analysis. Exercise interventions encompassed muscle-strengthening, cardiopulmonary enhancement, and increased walking steps, while nutrition interventions included protein, branched-chain amino acids (BCAAs), carbohydrates, and vitamins. Most interventions had a duration of 8-12 weeks. Significant improvements in skeletal muscle index [mean difference (MD): 0.53, P=0.01, 95% confidence interval (CI): -0.10, 0.96, I 2 =0%] and albumin (MD: 0.16, P=0.04, 95% CI: 0.01, 0.31, I 2 =0%) were observed in the experimental group when interventions extended for 12 months. Various indicators, such as thigh circumference, midarm circumference, and sit-to-stand, showed significant improvements within the experimental groups following interventions. Conclusions: Exercise and nutrition interventions demonstrate efficacy in improving sarcopenia in LC patients, with more pronounced effects observed with interventions lasting 12 months or longer. Skeletal muscle index and albumin levels in patients with LC can be positively influenced by exercise and nutrition strategies. Emphasizing a healthy diet and regular exercise is crucial for preventing sarcopenia in patients with LC.