Interventions to improve sarcopenia in cirrhosis: A systematic review

ARTICLE HIGHLIGHTS

Research background

Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis; and in cases of non-alcoholic fatty liver disease, it can contribute to accelerate liver fibrosis leading to cirrhosis.

Research motivation

It is imperative to study interventions which targets to improve sarcopenia in cirrhosis.

Research objectives

Aim of this systematic review of the literature was to examine the relationship between interventions and trans jugular intrahepatic portosystemic shunt (TIPS) to improve muscle mass in cirrhosis.

Research methods

We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above.

Research results

Twenty four studies that met review inclusion criteria were identified. The studies were diverse in terms of the design, setting, interventions, and outcome measurements. Only qualitative synthesis of evidence due to heterogeneity amongst studies was performed. 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. There are 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.

Research conclusions

Although the quality of evidence is low, the findings of this systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions.

Research perspectives

High quality randomized controlled trials are needed to further strengthen these findings.