Effect of amino acid-balanced diet-based nutritional-psychological intervention on muscle wasting and quality of life in cirrhosis patients

Abstract

BACKGROUND

Patients with liver cirrhosis often experience muscle wasting that significantly affects their quality of life.

AIM

To investigate the effects of comprehensive nutritional and psychological interventions based on an amino acid-balanced diet on muscle wasting and quality of life in patients with liver cirrhosis.

METHODS

A retrospective study of 130 patients with liver cirrhosis (May 2023 to June 2024) was divided into control (conventional treatment, n = 65) and observational groups (conventional + amino acid-balanced nutrition and psychological intervention, n = 65). Anxiety (Self-Rating Anxiety Scale), depression (Self-Rating Depression Scale), lower limb muscle strength, and quality of life (Chronic Liver Disease Questionnaire) were assessed pre-intervention, and 3/6 months post-intervention.

RESULTS

At baseline, no significant differences were observed between the two groups in terms of age, sex, etiology of cirrhosis, disease duration, disease severity, or any other measured outcome (P > 0.05). At 3 months and 6 months post-intervention, the observational group exhibited significantly lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores than the control group (P < 0.05), indicating reduced anxiety and depression as well as higher grip strength and increased lower limb muscle strength (P < 0.05). Additionally, the observational group demonstrated superior Chronic Liver Disease Questionnaire scores across all domains, reflecting an improved quality of life (P < 0.05).

CONCLUSION

An amino acid-balanced diet and psychological intervention can effectively alleviate anxiety and depression and improve muscle strength and quality of life in patients with cirrhosis and are worthy of clinical promotion.

Key Words: Cirrhosis; Sarcopenia; Amino acid balanced diet; Nutritional psychological intervention; Quality of life

Core Tip: This retrospective study of 130 cirrhosis patients compared conventional care (control) vs integrated amino acid-balanced dietary and psychological interventions (observation). At 3 months and 6 months, the observation group exhibited significantly lower anxiety/depression scores, greater grip and lower limb muscle strength, and superior quality of life (Chronic Liver Disease Questionnaire scores) vs controls (all P < 0.05). Findings suggest that amino acid-focused nutritional and psychological strategies mitigate muscle wasting and enhance psychosocial and physical outcomes in cirrhosis, warranting clinical adoption.

INTRODUCTION

Liver cirrhosis is a chronic, progressive and diffuse liver disease, which represents the terminal stage resulting from the long-term effects of various etiological factors on the liver[1]. Globally, both the incidence and mortality rates of liver cirrhosis are showing an upward trend. In China, liver cirrhosis remains a serious public health problem. With the high prevalence of viral hepatitis such as hepatitis B and hepatitis C, as well as the increasing incidence of alcoholic liver disease and non-alcoholic fatty liver disease, the number of patients with liver cirrhosis is continuously rising[2]. Studies have indicated that the patient population with liver cirrhosis in China is becoming younger[3]. Muscle wasting is one of the common complications in patients with liver cirrhosis. Sarcopenia and frailty are quite prevalent in patients with liver cirrhosis, and both of them can lead to an increase in the incidence and mortality rates[4]. Sarcopenia (severe muscle wasting) is a widespread muscle abnormality among patients with liver cirrhosis, contributing to poor prognosis both before and after liver transplantation[5]. Beyond these factors, a key metabolic cause is disrupted amino acid homeostasis, mainly the decreased ratio of branched-chain amino acids (BCAAs) - valine, leucine, isoleucine to aromatic amino acids (AAAs) - phenylalanine, tyrosine. In cirrhosis, impaired liver function reduces AAAs and BCAAs metabolism in the liver, leading to elevated serum AAAs (which can cross the blood-brain barrier and cause neuropsychiatric symptoms) and depleted BCAAs. BCAAs are critical for muscle protein synthesis (serving as nutrients and signaling molecules); leucine, in particular, strongly activates the mammalian target of rapamycin signaling pathway (a core regulator of protein synthesis). Thus, BCAA deficiency causes anabolic resistance and shifts toward muscle protein breakdown, worsening sarcopenia. The mechanisms involved are complex and primarily involve insufficient nutritional intake, malabsorption, decreased hepatic synthesis, and infection-induced reduction in protein synthesis leading to muscle breakdown[6]. Muscle wasting significantly affects patients with cirrhosis. It significantly deteriorates the patients’ quality of life, making basic activities like walking, dressing, and personal hygiene difficult. It also increases the risk of accidents such as falls and fractures, leading to physical disabilities, which severely affects the patients’ self-care ability and mental health[7]. From a physiological perspective, sarcopenia also elevates the risks of infections, ascites, hepatic encephalopathy, and perioperative complications in patients with liver cirrhosis, further exacerbating the condition, prolonging the hospital stay, and increasing the medical costs. Studies have shown that sarcopenia is independently associated with approximately a twofold increase in the risk of death in patients with liver cirrhosis. The mortality rate increases with the severity or duration of sarcopenia[8,9].

Quality of life is a crucial indicator of the health status of patients with liver cirrhosis[10]. It encompasses not only physical functions but also multiple dimensions such as psychological state and social function. For patients with liver cirrhosis, a good quality of life means being able to better cope with the disease and actively cooperate with treatment, thereby increasing the chances of survival and improving the quality of life. However, due to symptoms of the disease itself (such as fatigue, loss of appetite, abdominal distension, and pain, etc.) and concerns regarding prognosis, the quality of life of patients with liver cirrhosis is generally low. The occurrence of sarcopenia worsens the situation, further deteriorating patient physical function and psychological state and severely affecting their quality of life[11]. Currently, the treatment of sarcopenia in patients with liver cirrhosis mainly includes lifestyle modifications (such as quitting smoking and alcohol consumption, and improving sleep quality), nutritional interventions, physical exercises, and supportive drug therapies[12,13]. Nutritional intervention is considered a key measure for improving sarcopenia. A balanced amino acid diet, as a scientific and reasonable nutritional intervention method, can provide patients with sufficient amino acids in appropriate proportions, meeting the body’s demand for protein synthesis and helping to maintain and increase muscle mass[14]. Psychological factors are vitally important in the treatment and rehabilitation of patients with liver cirrhosis[15]. After being diagnosed with liver cirrhosis, patients often experience negative emotions such as anxiety, depression, and fear. These emotions can affect appetite, sleep, and treatment compliance, and further influence progression of the disease and retard the rehabilitation process[16]. Importantly, psychological interventions such as cognitive-behavioral therapy (CBT) can help patients adjust their mental state, relieve negative emotions, and enhance their confidence and ability to cope with the disease. A critical mechanism through which psychological intervention supports muscle recovery is improvement in overall treatment compliance. The existing literature indicates that psychological interventions can increase treatment compliance by 20%-30%[17,18].

Therefore, comprehensive nutritional and psychological interventions based on amino acid-balanced diets may offer new approaches and methods to reduce muscle wasting and improve quality of life in patients with liver cirrhosis[19]. By providing patients with an amino acid-balanced diet, ensuring adequate nutrient intake, and combining this with psychological interventions to help adjust their mental state and improve their psychological condition, there is potential for synergistic effects[20]. This could address muscle wasting in patients with liver cirrhosis and enhance their quality of life. Further research concerning the relationship among comprehensive nutritional and psychological interventions based on amino acid-balanced diets, muscle wasting, and quality of life in patients with liver cirrhosis is of significant clinical importance and practical value, potentially offering more effective strategies and methods for the treatment and rehabilitation of patients with liver cirrhosis.

MATERIALS AND METHODS

Participants

A total of 130 patients with liver cirrhosis admitted to our hospital between May 2023 and June 2024 were selected as research subjects. The patients were divided into control and observational groups based on their treatment method, with 65 patients in each group.

Inclusion criteria: (1) Meeting the diagnostic criteria of the “guidelines for the Diagnosis and Treatment of Liver Cirrhosis”; (2) Age 18-75 years; and (3) Complete clinical data.

Exclusion criteria: Patients with severe dysfunction of vital organs, such as the heart and kidney, mental illness rendering them unable to cooperate with treatment, and those who withdrew from treatment midway.

Control group intervention methods

Patients in the control group received routine treatment and care, including rest, dietary guidance (adhering to general principles of liver cirrhosis diet, such as high-calorie, high-protein, high-vitamin, easily digestible foods, avoiding coarse and hard foods), medication (providing hepatoprotective, enzyme-lowering, diuretic drugs based on the patient’s condition), and prevention and management of complications. Patients in the observational group, on top of the control group, received comprehensive nutritional and psychological interventions based on an amino acid-balanced diet.

Observational group intervention methods

Patients received comprehensive nutritional and psychological interventions for 6 months. The amino acid-balanced diet intervention featured personalized plans formulated by nutritionists based on patient condition, emphasizing high-quality protein intake with an animal-to-plant protein ratio maintained at 2:1. This was supplemented with 12 g/day of BCAAs (leucine, isoleucine, valine = 2:1:1) to address metabolic disorders. Macronutrient distribution included 60%-70% of calories from complex carbohydrates (primarily whole grains and tubers) to regulate digestion and blood glucose, while fat intake was controlled at 0.8-1.0 g/(kg/day) focusing on unsaturated fatty acids. Micronutrients, including fresh produce and supplements, were provided using tailored plans. Patients followed a 6-meal/day pattern (every 2.5-3.0 hours) to minimize fasting periods, with nutritionists regularly adjusting their plans for compliance. Concurrent psychological interventions comprised CBT (once every half month in the first month, for a total of two sessions; from February to June, this was adjusted to once a month for a total of five sessions; each intervention lasting 30 minutes), relaxation training (30-minute sessions thrice weekly, total 72 sessions, including breathing/muscle/meditation techniques), and monthly support groups with family involvement. Psychotherapists conducted evaluations in the first-month, third-month, and sixth-month Self-Rating Depression Scale (SDS)/Self-Rating Anxiety Scale (SAS) assessments to monitor psychological status and dynamically adjust the interventions.

Observation indicators

Muscle strength indicators: Grip strength was measured using a handheld dynamometer and lower limb muscle strength was evaluated using specialized medical muscle strength testing equipment.

Assessment of anxiety and depression: SAS and SDS were used for psychological assessments. The SAS comprises 20 items, each scored on a 4-point Likert scale (1-4). Among them, 15 items were positively worded, and five were negatively worded. The raw scores of all the items were summed and converted into standard scores using a specific formula. A standard score < 50 indicates a normal psychological status, 50-59 suggests mild anxiety, 60-69 represents moderate anxiety, and 70 or above indicates severe anxiety. The SDS consists of 20 items with identical scoring mechanisms. A standard score < 53 was considered normal, 53-62 indicates mild depression, 63-72 represents moderate depression, and 73 or higher indicated severe depression.

Quality of life assessment: The Chronic Liver Disease Questionnaire (CLDQ) scoring scale was used to assess patients in both groups before intervention, at 3 months post-intervention, and at 6 months post-intervention. The CLDQ is a specialized assessment tool designed for patients with chronic liver diseases. It comprises six dimensions-emotional function, systemic symptoms, abdominal symptoms, fatigue, activity, and worry-with 29 items. Each item is scored on a 7-point scale. The score for each dimension was calculated as the total score of the items within that dimension divided by the number of items. Higher scores indicate a better quality of life.

Statistical methods

Statistical software SPSS version 26.0 was used to analyze and process collected data. For quantitative data, means ± SD were used for representation, and independent samples t-tests were applied for comparisons between the two groups, while ANOVA was used for comparisons among multiple groups. Mann-Whitney U-tests were applied for comparisons between two groups, while Kruskal-Wallis H-tests were used for comparisons among multiple groups. For categorical data, frequency, and percentage [n (%)] were used for representation, and χ² tests were applied for comparisons between two groups, with Fisher’s exact probability method used when the theoretical frequency was < 5. Correlation analysis was conducted using either Pearson’s or Spearman’s correlation coefficients, depending on the data type and distribution, to explore the relationship between muscle wasting-related indicators and scores in various dimensions of quality of life. P < 0.05 was considered statistically significant, and all statistical tests were two-tailed.

RESULTS

Analysis of general patient data

This study included 130 patients with liver cirrhosis who were divided into a control group and an observation group according to the treatment method, with 65 patients in each group. The general information of the patients in both groups is shown in Table 1. Statistical tests showed that there were no significant differences between the two groups in terms of gender, age, Child-Pugh classification, and etiology (P > 0.05), indicating comparability.

Table 1 Comparison of general data of two groups of patients, mean ± SD.

Group	Examples	Gender (male/female)	Age (years)	Child-Pugh grading (A; B; C)	Cause (hepatitis B; hepatitis C; alcohol-related; other)
Control group	65	35/30	52.3 ± 8.5	20; 30; 15	35; 10; 15; 5
Observation group	65	33/32	51.8 ± 9.2	22; 28; 15	33; 12; 14; 6
t		0.135	0.335	0.246	0.374
P value		0.713	0.738	0.884	0.945

Changes in quality-of-life indicators

A comparison of the CLDQ scores between the two groups of patients before intervention, at three months post-intervention, and at six months post-intervention showed no statistically significant differences in any of the CLDQ item scores or in total scores between the two groups before intervention (P > 0.05). At three months and six months post-intervention, the item and total scores of the CLDQ in both groups were significantly higher than before intervention, with the scores at three months post-intervention being notably higher than those before intervention. Moreover, the CLDQ item and total scores of the observational group at three months and six months post-intervention were significantly higher than those of the control group, with all differences being statistically significant (P < 0.05; Table 2).

Table 2 The scores of each dimension of the quality-of-life assessment questionnaire for the two groups of patients before and after the intervention (points), mean ± SD.

Group	n	Time	Fatigue	Emotional function	Abdominal symptoms	Systemic symptoms	Activity	Worry	Total score	P value (between-group)
Observation group	65	Before intervention	3.84 ± 0.91	3.72 ± 0.89	3.52 ± 0.85	3.78 ± 0.90	3.61 ± 0.87	3.91 ± 0.93	22.38 ± 2.185	> 0.05
		Intervention for 3 months	4.78 ± 1.02	4.56 ± 0.97	4.36 ± 0.95	4.75 ± 1.02	4.56 ± 0.98	4.85 ± 1.02	27.86 ± 2.4351	< 0.001
		Intervention 6 months	5.28 ± 1.05	5.12 ± 1.02	4.85 ± 1.02	5.25 ± 1.05	5.02 ± 1.02	5.35 ± 1.05	30.87 ± 2.5352	< 0.001
		Overall within-group	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
Control group	65	Before intervention	3.88 ± 0.93	3.76 ± 0.91	3.56 ± 0.87	3.82 ± 0.92	3.65 ± 0.89	3.95 ± 0.95	22.63 ± 2.234	> 0.05
		Intervention for 3 months	4.18 ± 0.95	4.05 ± 0.93	3.85 ± 0.90	4.12 ± 0.95	3.95 ± 0.92	4.25 ± 0.97	24.40 ± 2.2951	< 0.001
		Intervention 6 months	4.48 ± 0.97	4.35 ± 0.95	4.12 ± 0.92	4.42 ± 0.97	4.25 ± 0.95	4.55 ± 0.98	26.17 ± 2.3442	< 0.001
		Overall within-group	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

¹Significant difference compared with the same group before intervention.

²Significant difference compared with the same group 3 months after intervention and compared with the same group before intervention.

Intergroup comparisons were performed using independent samples t-tests; intra-group comparisons were performed using repeated measures analysis of variance, with post hoc tests using Bonferroni correction.

Anxiety and depression assessments in both groups of patients after intervention

Before intervention, there were no statistically significant differences in SAS and SDS scores between the two groups (P > 0.05). After intervention, the observational group’s SAS and SDS scores were lower than those before the intervention, and the observational group’s values were also lower than those of the control group, with the difference being statistically significant (P < 0.05; Table 3).

Table 3 Assessment of anxiety and depression in two groups of patients before and after intervention (points), mean ± SD.

Group (n)	SAS			SDS
	Before intervention	3 months after intervention	6 months after intervention	Before intervention	3 months after intervention	6 months after intervention
Observation group (65)	54.3 ± 3.2	46.7 ± 2.5	42.5 ± 2.0	56.1 ± 2.8	48.3 ± 2.2	44.1 ± 1.8
Control group (65)	53.9 ± 3.5	52.1 ± 3.0	51.3 ± 2.8	55.8 ± 3.1	54.5 ± 2.6	53.7 ± 2.4
t	0.376	13.599	16.374	0.582	10.755	11.134
P value	0.769	< 0.001	< 0.001	0.741	< 0.001	< 0.001

SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Changes in muscle strength indicators

Both groups exhibited increases in grip and knee extension strength after intervention, with more significant increases observed in the observation group. The differences at different time points within the group and between groups were statistically significant (P < 0.05), and there was an interaction effect between time and group (P < 0.05). This indicates that comprehensive nutritional and psychological interventions based on amino acid-balanced diets have a more pronounced effect on improving muscle strength in patients with liver cirrhosis (Tables 4 and 5).

Table 4 The changes of muscle strength indexes such as grip strength before and after intervention in two groups of patients, mean ± SD.

Group	Examples	Time	The power of gripping (kg)	Knee extension strength (Newton)
Control group	65	Before intervention	22.35 ± 4.12	125.36 ± 20.15
		Intervention lasted for 3 months	22.68 ± 4.20	128.56 ± 21.08
		Intervention 6 months	22.95 ± 4.25	130.25 ± 21.50
Observation group	65	Before intervention	22.18 ± 4.05	124.89 ± 19.87
		Intervention for 3 months	23.45 ± 4.35	135.68 ± 22.36
		Intervention for 6 months	24.20 ± 4.45	142.36 ± 23.50

Table 5 The repeated measurement variance analysis of grip strength and knee extension strength in two groups of patients at different time points.

Metric	Time	Group F value	P value	Group F value	P value	Time × inter-group F value	P value
The power of gripping	Before intervention, 3 months and 6 months	16.325	< 0.001	12.568	< 0.001	14.874	< 0.001
Knee extension strength	Before intervention, 3 months and 6 months	17.256	< 0.001	13.654	< 0.001	15.987	< 0.001

Changes in liver function markers

The observation group displayed significant improvements in all liver function markers at 3/6 months (P < 0.05 vs baseline and control group). Control group had no significant changes (P > 0.05; Table 6).

Table 6 Dynamic changes in liver function indicators, mean ± SD.

Indicator	Group	Baseline	3 months	6 months	P value (time × group)2
ALT (U/L)	Control group	68.3 ± 12.1	65.7 ± 11.8	67.2 ± 10.9	0.032
	Observation group	67.9 ± 13.5	58.2 ± 9.71	52.4 ± 8.31
AST (U/L)	Control group	75.6 ± 14.2	73.8 ± 13.6	74.1 ± 12.7	0.021
	Observation group	76.1 ± 15.0	66.3 ± 10.81	60.5 ± 9.41
Albumin (g/L)	Control group	31.2 ± 2.8	32.0 ± 3.1	31.7 ± 2.9	0.019
	Observation group	30.8 ± 3.0	34.5 ± 2.71	36.8 ± 2.51
Prealbumin (mg/L)	Control group	120.5 ± 15.7	125.3 ± 16.2	123.1 ± 14.9	0.008
	Observation group	118.7 ± 16.3	142.6 ± 18.11	158.3 ± 17.51
Total bilirubin (μmol/L)	Control group	42.5 ± 6.8	40.1 ± 6.2	41.3 ± 5.9	0.045
	Observation group	43.2 ± 7.1	36.7 ± 5.81	32.4 ± 4.71

¹Significant difference compared to before intervention within the same group and compared to control group at the same time point.

²Interaction effect by repeated-measures ANOVA, control group showed no significant changes from baseline at any time point (all P > 0.05); observation group showed significant improvements in all indicators at 3/6 months vs baseline and 3/6 months vs control group.

DISCUSSION

The results of this study indicate that comprehensive nutritional and psychological interventions based on an amino acid-balanced diet can significantly improve muscle atrophy in patients with liver cirrhosis. In terms of muscle quality indicators, the intervention group showed remarkable improvements in muscle quality and skeletal muscle index after treatment. Comparisons at different time points within the group and between groups demonstrated statistically significant differences (P < 0.05). This is mainly attributed to the fact that an amino acid-balanced diet provides sufficient amino acids in appropriate proportions to meet muscle synthesis needs. BCAAs play a crucial role in this process, as they can be directly absorbed and utilized by muscle tissues, promoting the synthesis of muscle proteins and reducing their breakdown. Studies have shown that leucine, as one type of BCAA, can activate the mammalian target of rapamycin signaling pathway, enhance the expression of genes related to protein synthesis, and increase ribosomal biosynthesis, thus accelerating the process of muscle protein synthesis[21-23]. Additionally, an amino acid-balanced diet can regulate myostatin expression, reduce its inhibitory effect on muscle growth, and promote muscle growth and repair.

In terms of muscle strength indicators, the increases in grip strength and knee extension strength in the intervention group were significantly greater than those in the control group after intervention. Both intra-group comparisons at different time points and inter-group comparisons revealed statistically significant differences (P < 0.05). This is because a balanced amino acid diet not only provides the material foundation for muscle synthesis, but also improves the metabolic environment of muscles, enhancing their contraction ability. At the same time, psychological intervention played a certain auxiliary role. Psychological intervention improved the patients’ mental state, increased treatment compliance, and made patients cooperate more actively with dietary interventions and rehabilitation training, thereby further promoting muscle strength improvement. Studies have shown that a positive mental state can enhance patient motivation and confidence in participating in rehabilitation training, improve training effectiveness, and contribute to the recovery and enhancement of muscle strength.

The results of this study are consistent with the conclusions of related research[24]. For example, a study conducted in patients with liver cirrhosis found that after receiving nutritional supplements rich in BCAAs, the patients’ muscle mass and muscle strength were significantly improved, which is in accord with the findings of this study regarding improvements in muscle mass and muscle strength following an amino acid-balanced diet. Another study showed that psychological interventions can enhance patient enthusiasm and compliance with rehabilitation, thereby exerting a positive impact on muscle function recovery[25]. This study further confirms the effectiveness of comprehensive nutritional intervention and psychological interventions in improving sarcopenia in patients with liver cirrhosis, providing a more comprehensive theoretical basis and practical guidance for clinical treatment.

In this study, comprehensive nutritional and psychological interventions based on an amino acid-balanced diet significantly improved the quality of life in patients with liver cirrhosis. From changes in the scale scores and aspects covered by the CLDQ scale, such as abdominal symptoms, systemic symptoms, activity, emotional function, worry, and fatigue, the score improvement in the intervention group of patients was significantly greater than that in the control group at all time points within the group and between groups, with statistically significant differences (P < 0.05).

From a physiological perspective, an amino acid-balanced diet provides patients with adequate nutrition to meet the body’s needs for proteins, carbohydrates, fats, vitamins, and minerals, thereby improving their nutritional status. This helps to enhance physical strength and immunity, alleviate symptoms such as fatigue and weakness caused by malnutrition, and allow patients to better engage in daily activities, thus improving the quality of life in terms of physiological function, vitality, and physical pain. For example, sufficient protein intake provides raw materials for muscle synthesis, alleviates muscle wasting, and enhances muscle strength, making patients more comfortable and agile during activities such as walking and climbing stairs. Simultaneously, a well-balanced diet aids in maintaining stable metabolic indicators, such as blood glucose and lipids, reducing hepatic metabolic burden, promoting liver function recovery, and ultimately improving overall patient health.

At the psychological level, psychological intervention can play crucial roles[26]. CBT helps patients change their negative perceptions of the disease and their pessimistic thinking patterns, enhancing their confidence in overcoming the disease and their sense of self-control. Patients transform from an initial state of pessimism and despair, believing “i will definitely not get better”, to actively facing the disease and cooperating with the treatment. This shift in psychological state is of great significance for improving quality of life[27]. Relaxation training and meditation can effectively alleviate patients’ anxiety and depressive emotions, relieve psychological stress, and improve mental health. Psychological support and (patient support groups) provide a platform for emotional communication, enabling patients to feel cared for and supported by others. By enhancing social support, these measures improve quality of life in terms of emotional function and mental health. For instance, patients share their treatment experiences and psychological feelings at support group meetings and encourage each other, which is helpful in improving their psychological state and quality of life.

The patient’s subjective feedback further confirms the positive impact of comprehensive nutritional psychological intervention on quality of life. In the observation group, the proportion of patients who reported a significant improvement or some improvement in their quality of life was significantly higher than in the control group, while those who reported no significant change or deterioration were fewer compared to the control group. This indicates that comprehensive intervention not only improved patients’ quality of life objectively but also allowed them to genuinely experience an enhancement in their quality of life subjectively, making patients more satisfied with treatment and hopeful about their future lives. Our findings demonstrate that combining amino acid-balanced nutrition with psychological support yields synergistic efficacy, significantly improving muscle strength, reducing anxiety/depression (SAS/SDS), and enhancing quality of life (CLDQ) beyond conventional care alone. These gains translate to critical clinical relevance: Elevated physical activity capacity from improved muscle mass directly enhances daily functioning and quality of life, establishing this dual approach as a viable clinical strategy. Looking forward, future efforts should focus on optimizing amino acid formulas for personalized dietary plans, integrating telemedicine/digital platforms to scale interventions, and strengthening multidisciplinary collaboration (hepatology, nutrition, psychiatry) to standardize sarcopenia management - particularly in resource-limited settings.

Meanwhile, This study has three key limitations: (1) The absence of direct comparator groups (e.g., BCAA supplementation alone or standalone psychological intervention) precludes definitive assessment of the combined intervention’s relative superiority; (2) The multi-disciplinary collaboration model required for overall management faces unique obstacles in hospital implementation (such as prominent barriers to collaboration between departments, complex cross-departmental process integration, and insufficient collaborative efficiency under high workloads), which limits its in-depth application and effectiveness in actual clinical scenarios; and (3) Retrospective non-randomized grouping may introduce selection bias, the sample size is relatively small and the single-center design limits the generalizability, the follow-up period is short, and the long-term effects and safety are unknown. Future studies need to further verify through large sample, randomized controlled, long-term follow-up and mechanism clarification.

CONCLUSION

In summary, sarcopenia is closely related to the quality of life in patients with liver cirrhosis, and the two conditions influence each other. Improving sarcopenia is of great significance for enhancing the quality of life in patients with liver cirrhosis. In clinical treatment, it is essential to place high importance on the prevention and management of sarcopenia. Effective interventions, such as comprehensive nutritional and psychological interventions based on amino acid-balanced diets, can improve muscle status, thereby comprehensively enhancing the overall quality of life for patients.