Implications of pre-transplant sarcopenia and frailty in patients with non-alcoholic steatohepatitis and alcoholic liver disease

被引:7
作者
Redman, Joseph S. [1 ]
Kaspar, Matt [1 ]
Puri, Puneet [1 ,2 ]
机构
[1] Virginia Commonwealth Univ, West Hosp, Div Gastroenterol Hepatol & Nutr, Richmond, VA USA
[2] Hunter Holmes McGuire VA Med Ctr, Div Gastroenterol Hepatol & Nutr, 1201 Broad Rock Blvd, Richmond, VA 23249 USA
关键词
Sarcopenia; frailty; non-alcoholic steatohepatitis (NASH); alcohol; transplant; SEVERE MUSCLE DEPLETION; SKELETAL-MUSCLE; HEPATIC-ENCEPHALOPATHY; NITROGEN-METABOLISM; PROTEIN-SYNTHESIS; MASS INDEX; CIRRHOSIS; SURVIVAL; MORTALITY; RISK;
D O I
10.21037/tgh-20-236
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Frailty manifesting as sarcopenia is an independent risk factor for mortality in cirrhosis, and often presents in low model for end-stage liver disease (MELD) patients. Its etiology is multifactorial, but key physiologic changes culminate in altered energy utilization in the fasting state, preferentially utilizing muscle amino acids for gluconeogenesis thereby promoting sarcopenia. Hyperammonemia alters the circulating amino acid profile, diminishing pro-muscle branched-chain amino acids like leucine. The metabolic syndrome worsens sarcopenia through multi-tissue insulin resistance. Alcohol also exacerbates sarcopenia as a direct muscle toxin and inhibitor of growth signaling. Therapy is aimed at alcohol cessation, frequent high-protein meals, branched-chain amino acid supplementation, and diminished time spent fasting. Moderate exercise can improve muscle mass and muscle quality, though precise exercise regimens have not yet been explicitly determined. Studies are ongoing into the effects of myostatin antagonists and insulin sensitizers. The Liver Frailty Index can predict patients most at risk of poor outcome and should be considered in the management of all cirrhotic patients. Specialty testing like dual-energy X- ray absorptiometry (DEXA) scanning and cross-sectional estimates of muscle mass are areas of active research and may play a future role in clinical risk-stratification.
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页数:11
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