Interventions to improve sarcopenia in cirrhosis: A systematic review
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摘要
BACKGROUND Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation, exercise, combined life style intervention, testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS) to improve muscle mass in cirrhosis.METHODS We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles(RCTs, clinical trial, comparative study)in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above. In the screening process, 154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, interventions, and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies. Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass, strength and physical function following aerobic exercise. 60% of the included studies on the nutritional intervention, 100% of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.CONCLUSION Although the quality of evidence is low, the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions. High quality randomized controlled trials needed to further strengthen these findings.
BACKGROUND Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation, exercise, combined life style intervention, testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS) to improve muscle mass in cirrhosis.METHODS We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles(RCTs, clinical trial, comparative study)in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above. In the screening process, 154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, interventions, and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies. Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass, strength and physical function following aerobic exercise. 60% of the included studies on the nutritional intervention, 100% of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.CONCLUSION Although the quality of evidence is low, the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions. High quality randomized controlled trials needed to further strengthen these findings.
BACKGROUND Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation, exercise, combined life style intervention, testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS) to improve muscle mass in cirrhosis.METHODS We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles(RCTs, clinical trial, comparative study)in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above. In the screening process, 154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, interventions, and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies. Risk of bias was medium in most of the included studies and low quality of evidence showed improvement in the muscle mass, strength and physical function following aerobic exercise. 60% of the included studies on the nutritional intervention, 100% of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.CONCLUSION Although the quality of evidence is low, the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions. High quality randomized controlled trials needed to further strengthen these findings.
引文
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2 Metter EJ,Conwit R,Tobin J,Fozard JL.Age-associated loss of power and strength in the upper extremities in women and men.J Gerontol A Biol Sci Med Sci 1997;52:B267-B276[PMID:9310077DOI:10.1093/gerona/52A.5.B267]
3 Lautz HU,Selberg O,K?rber J,Bürger M,Müller MJ.Protein-calorie malnutrition in liver cirrhosis.Clin Investig 1992;70:478-486[PMID:1392415 DOI:10.1007/BF00210228]
4 Montano-Loza AJ,Meza-Junco J,Prado CM,Lieffers JR,Baracos VE,Bain VG,Sawyer MB.Muscle wasting is associated with mortality in patients with cirrhosis.Clin Gastroenterol Hepatol 2012;10:166-173,173.e1[PMID:21893129]
5 Dasarathy S.Consilience in sarcopenia of cirrhosis.J Cachexia Sarcopenia Muscle 2012;3:225-237[PMID:22648736 DOI:10.1007/s13539-012-0069-3]
6 Das A,Dhiman RK,Saraswat VA,Verma M,Naik SR.Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis.J Gastroenterol Hepatol 2001;16:531-535[PMID:11350549 DOI:10.1046/j.1440-1746.2001.02487.x]
7 Kalaitzakis E,Josefsson A,Castedal M,Henfridsson P,Bengtsson M,Andersson B,Bj?rnsson E.Hepatic encephalopathy is related to anemia and fat-free mass depletion in liver transplant candidates with cirrhosis.Scand J Gastroenterol 2013;48:577-584[PMID:23452072 DOI:10.3109/00365521.2013.777468]
8 Periyalwar P,Dasarathy S.Malnutrition in cirrhosis:contribution and consequences of sarcopenia on metabolic and clinical responses.Clin Liver Dis 2012;16:95-131[PMID:22321468 DOI:10.1016/j.cld.2011.12.009]
9 Merli M,Riggio O,Dally L.Does malnutrition affect survival in cirrhosis?PINC(Policentrica Italiana Nutrizione Cirrosi).Hepatology 1996;23:1041-1046[PMID:8621131 DOI:10.1002/hep.510230516]
10 Kaido T,Ogawa K,Fujimoto Y,Ogura Y,Hata K,Ito T,Tomiyama K,Yagi S,Mori A,Uemoto S.Impact of sarcopenia on survival in patients undergoing living donor liver transplantation.Am J Transplant2013;13:1549-1556[PMID:23601159 DOI:10.1111/ajt.12221]
11 Tandon P,Ney M,Irwin I,Ma MM,Gramlich L,Bain VG,Esfandiari N,Baracos V,Montano-Loza AJ,Myers RP.Severe muscle depletion in patients on the liver transplant wait list:its prevalence and independent prognostic value.Liver Transpl 2012;18:1209-1216[PMID:22740290 DOI:10.1002/lt.23495]
12 Tsien C,Garber A,Narayanan A,Shah SN,Barnes D,Eghtesad B,Fung J,McCullough AJ,Dasarathy S.Post-liver transplantation sarcopenia in cirrhosis:a prospective evaluation.J Gastroenterol Hepatol 2014;29:1250-1257[PMID:24443785 DOI:10.1111/jgh.12524]
13 Hamaguchi Y,Kaido T,Okumura S,Fujimoto Y,Ogawa K,Mori A,Hammad A,Tamai Y,Inagaki N,Uemoto S.Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation.Liver Transpl 2014;20:1413-1419[PMID:25088484 DOI:10.1002/lt.23970]
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