Sarcopenia and malnutrition in patients with liver diseases

Abstract

This review focuses on the most current  information  on the pathogenesis, diagnosis  and treatment of sarcopenia and malnutrition in patients with liver disease. Sarcopenia  and malnutrition are common complications of liver diseases. Liver cirrhosis, as a stage  of the pathological process, serves as the main predisposing factor for the development of malnutrition and sarcopenia. The frequency  of sarcopenia in liver cirrhosis  is 30–50%  and  reaches  100% in decompensated patients. The main pathogenetic links are: impaired  proteostasis of skeletal  muscles, systemic  inflammation and changes  in gut microbiota. In recent   years, enough   data  have  been  accumulated  to  consider  these   conditions   as  a  prognostically unfavorable   factor in patients with liver cirrhosis of various etiologies,  affecting  their quality of life and survival, as well as worsening  the out-comes  of transplantation. This dictates  the  necessity  to  define  unified  approaches to  diagnostics and  correction  of these conditions. Currently, tests are used for diagnosis, which allow to assess muscle strength and function. Muscle mass is assessed using instrumental methods by measuring  individual  muscles  and calculating skeletal  muscle  indices. In patients with liver cirrhosis and concomitant sarcopenia and malnutrition, nutritional and lifestyle modification  strategies are applicable for correction  in addition  to therapy  aimed at elimination of the etiologic  factor. The aim of the review is to evaluate the problems of diagnosis and effective treatment of malnutrition and sarcopenia in patients with liver disease  based on literature data. The article presents an overview of the main strategies for the approach, diagnosis  and correction  of these  conditions.