John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Sarcopenia and cirrhosis the silent enemy Volume 27, issue 10, Décembre 2020

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Authors
1 Hôpitaux Universitaires Paris-Seine-Saint-Denis, Hôpital Avicenne, Service d’hépatologie, Bobigny
2 Communauté d’Universités et Établissements Sorbonne Paris Cité, Université Paris 13, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Paris
3 Sorbonne Universités, Inserm, UMRS-1138, Sorbonne Université, Centre de Recherche des Cordeliers, F-75006 Paris
4 Université Paris 13, Université Paris Diderot, Université Paris Descartes, USPC, Functional Genomics of Solid Tumors, F-75006 Paris, France
5 Hôpitaux Universitaires Paris-Seine-Saint-Denis, Hôpital Avicenne, Radiologie interventionnelle, Bobigny
6 Centre de recherche sur l’inflammation, INSERM UMR 1149, Paris
* Correspondance

Sarcopenia in liver diseases is defined by a global reduction in muscle mass and muscle function due to acute or chronic liver disease. Current recommendations advice to include an assessment of sarcopenia in the nutritional evaluation in all patients with chronic liver disease. The main pathophysiological mechanisms involved in the process of sarcopenia are autophagy, hyper activation of the ubiquitin/proteasome system and activation of the mTOR pathway. The occurence of sarcopenia is multifactorial; the presence of hyperammonemia, decreased blood levels of testosterone and growth factors or branched chain amino acids play an important role. Assessment of sarcopenia can be performed functionally or morphologically ; the most widespread method used for the evaluation of sarcopenia is the measurement of the skeletal muscle area by tomography scanner (skeletal muscle area, SMA) at the level of the third lumbar vertebra with thresholds for sarcopenia set at <50 cm2/m2 in men and <39 cm2/m2 in women. Several groups have considered the diameter or area of the psoas muscle by computed tomography as a simple and reliable alternative. The negative prognostic impact of sarcopenia in patients awaiting liver transplantation or after liver transplantation is well established. Moreover, sarcopenia is also a poor prognostic factor in patients with hepatocellular carcinoma (HCC) developed on cirrhosis. Several studies have suggested the positive role of physical exercise with an improvement in sarcopenia in the cirrhotic patient. The nutritional aspect is a key point for the management of sarcopenia. A cirrhotic patient should have an energy intake of at least 35 kcal/kg/d and a protein intake between 1.2 and 1.5 g/kg/d to which is added a night snack and possibly a supplementation of branched amino acids in some cases.