Sarcopenia in patients with cirrhosis means the loss of muscle mass and decreased functional capacity, along with a greater risk for morbidity and mortality. It is one of the most common complications in patients of cirrhosis, affecting 30% to 70%. This condition is of significant concern as sarcopenia has been associated with decreased quality of life, increased hospital admissions, increased risk for other complications related with cirrhosis like jaundice, ascites, hepatic encephalopathy and upper gastrointestinal tract bleeding, higher mortality and worse post-liver transplant outcomes.
Sarcopenia in cirrhosis is known to occur due to the alterations in protein turnover, energy disposal, and hormonal and metabolic changes which lead to muscle depletion.
Some of the causes of Sarcopenia in cirrhosis are:
Malnutrition and malabsorption
Altered lipid and amino acid metabolism
Decreased hepatic ammonia clearance
Increased inflammatory mediators
Increased myostatin
Decreased anabolic hormones
Decreased physical activity
Diagnosis of sarcopenia:
The diagnosis of sarcopenia is usually not straightforward. It includes quantifying the loss of skeletal muscle mass and function which requires analysis of the body composition using one or more of a number of available techniques like anthropometry, DEXA scanning, bioelectrical impedance analysis, plethysmography, ultrasonography and CT or MRI.
Treatment:
The treatment of sarcopenia includes dietary modifications-high protein, branched-chain amino acid-rich, hyperammonemia lowering diet. It requires modifying the protein and calorie supplementation of cirrhotic patients which goes a long way in building up the muscle mass.
The other important aspect of management of sarcopenia involves physical activity which is tailor-made muscle strengthening exercises for individual patients and done under the supervision of expert physiotherapists.
Medication includes branched-chain amino acid-like isoleucine and valine, a hormonal treatment which involves supplementation with testosterone and growth hormone. Consult a Hepatologist and get yourself evaluated if you suffer from cirrhosis, feel tired all day long and are getting weaker day by day.
We at Aster RV hospital have a highly specialized integrated liver care unit which can help you manage your liver-related problems.
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