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| 1 | Clinical relevance of sarcopenia in patients with cirrhosis显示文摘The most commonly recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, susceptibility for infections, kidney dysfunction, and hepatocellular carcinoma; however, severe muscle wasting or sarcopenia are the most common and frequently unseen complications which negatively impact survival, quality of life, and response to stressor, such as infections and surgeries. At present, D'Amico stage classification, Child-Pugh, and MELD scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of assessing the nutritional and functional status. Currently, numerous methods are available to evaluate the nutrition status of the cirrhotic patient; nevertheless, most of these techniques have limitations primarily because lack of objectivity, reproducibility, and prognosis discrimination. In this regard, an objective and reproducible technique, such as muscle mass quantification with cross-sectional imaging studies(computed tomography scan or magnetic resonance imaging) constitute an attractive index of nutritional status in cirrhosis. Sarcopenia is part of the frailty complex present in cirrhotic patients, resulting from cumulative declines across multiple physiologic systems and characterized by impaired functionalcapacity, decreased reserve, resistance to stressors, and predisposition to poor outcomes. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis. Also, we analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in patients with cirrhosis and their impact after liver transplantation. Finally, we discuss existing and potential novel therapeutic approaches for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in an effort to reduced morbidity related and improved survival in cirrhosis. | Aldo J Montano-Loza | 2014 | World Journal of Gastroenterology2014，20，25： | 17 |
| 2 | Gut microbiota in common elderly diseases affecting activities of daily living显示文摘Gut microbiota are involved in the development or prevention of various diseases such as type 2 diabetes,fatty liver, and malignancy such as colorectal cancer,breast cancer and hepatocellular carcinoma. Alzheimer'sdisease, osteoporosis, sarcopenia, atherosclerotic stroke and cardiovascular disease are major diseases associated with decreased activities of daily living(ADL), especially in elderly people. Recent analyses have revealed the importance of gut microbiota in the control of these diseases. The composition or diversity of these microbiota is different between patients with these conditions and healthy controls, and administration of probiotics or prebiotics has been shown effective in the treatment of these diseases. Gut microbiota may affect distant organs through mechanisms that include regulating the absorption of nutrients and/or the production of microbial metabolites, regulating and interacting with the systemic immune system, and translocating bacteria/bacterial products through disrupted mucosal barriers.Thus, the gut microbiota may be important regulators in the development of diseases that affect ADL. Although adequate exercise and proper diet are important for preventing these diseases, their combination with interventions that manipulate the composition and/or diversity of gut microbiota could be a promising strategy for maintaining health condition and preserving ADL. This review thus summarizes current understanding of the role of gut microbiota in the development or prevention of diseases closely associated with the maintenance of ADL. | Yukihiro Shimizu | 2018 | World Journal of Gastroenterology2018，24，42： | 15 |
| 3 | Sarcopenia之研究进展显示文摘 | 李文惠 赵斌 汤艳美 安梅菊 | 2010 | 中国老年学杂志2010，30，19： | 14 |
| 4 | Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score显示文摘Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for endstage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research. | Hee Yeon Kim Jeong Won Jang | 2015 | World Journal of Gastroenterology2015，21，25： | 11 |
| 5 | Nutritional issues in patients with obesity and cirrhosis显示文摘Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis.Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis.Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronicliver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation.Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble,water-soluble vitamins and trace elements and should be supplemented appropriately.Diet,physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations.Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation.The risk of sarcopenia,micronutrient status,and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review.Furthermore,the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed. | Luigi Schiavo Luca Busetto Manuela Cesaretti Shira Zelber-Sagi Liat Deutsch Antonio Iannelli | 2018 | World Journal of Gastroenterology2018，24，30： | 9 |
| 6 | Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery显示文摘According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation- equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on Pub Med and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia- the loss of muscle mass- is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient's peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the preoperative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been demonstrated among the strongest predictors of both short- and longterm outcome following complicated surgical procedures such as esophageal, gastric, colorectal, and hepatopancreatico-biliary resections. | doris wagner mara mcadams demarco neda amini stefan buttner dorry segev faiz gani timothy m pawlik | 2016 | World Journal of Gastrointestinal Surgery2016，8，1： | 8 |
| 7 | Sarcopenia诊断方法和标准研究进展显示文摘有研究预测.未来五十年。我国60岁以上人口将从目前的10.9%增至35.8%。而80岁以上人口将增至6.8%。伴随人口老龄化,各种老年疾病的发病率大幅增加。在现阶段。进行各种老年人疾病预防和治疗的研究对于今后我国医疗开支的减少、老年人生活质量的提高具有重要意义。 | 温煦 付倩 安平 | 2014 | 中国运动医学杂志2014，33，4： | 8 |
| 8 | Interventions to improve sarcopenia in cirrhosis: A systematic review显示文摘BACKGROUND Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis and in cases of non-alcoholic fatty liver disease can contribute to accelerate liver fibrosis leading to cirrhosis. Hence, it is imperative to study interventions which targets to improve sarcopenia in cirrhosis.AIM To examine the relationship between interventions such nutritional supplementation, exercise, combined life style intervention, testosterone replacement and trans jugular intrahepatic portosystemic shunt(TIPS) to improve muscle mass in cirrhosis.METHODS We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles(RCTs, clinical trial, comparative study)in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above. In the screening process, 154 full text articles were included in the review and 129 studies were excluded.RESULTS We identified 24 studies that met review inclusion criteria. The studies were diverse in terms of the design, setting, interventions, and outcome measurements.We performed only qualitative synthesis of evidence due to heterogeneity amongst studies. 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. 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.CONCLUSION Although the quality of evidence is low, the findings of our systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions. High quality randomized controlled trials needed to further strengthen these findings. | Maliha Naseer Erica P Turse Ali Syed Francis E Dailey Mallak Zatreh Veysel Tahan | 2019 | World Journal of Clinical Cases2019，7，2： | 8 |
| 9 | Malnutrition in cirrhosis:More food for thought显示文摘Malnutrition is highly prevalent in liver cirrhosis and its presence carries important prognostic implications.The clinical conditions and pathophysiological mechanisms that cause malnutrition in cirrhosis are multiple and interrelated.Anorexia and liver decompensation symptoms lead to poor dietary intake;metabolic changes characterised by elevated energy expenditure,reduced glycogen storage,an accelerated starvation response and protein catabolism result in muscle and fat wasting;and,malabsorption renders the cirrhotic patient unable to fully absorb or utilise food that has been consumed.Malnutrition is therefore a considerable challenge to manage effectively,particularly as liver disease progresses.A high energy,high protein diet is recognised as standard of care,yet patients struggle to follow this recommendation and there is limited evidence to guide malnutrition interventions in cirrhosis and liver transplantation.In this review,we seek to detail the factors which contribute to poor nutritional status in liver disease,and highlight complexities far greater than“poor appetite”or“reduced oral intake”leading to malnutrition.We also discuss management strategies to optimise nutritional status in this patient group,which target the inter-related mechanisms unique to advanced liver disease.Finally,future research requirements are suggested,to develop effective treatments for one of the most common and debilitating complications afflicting cirrhotic patients. | Brooke Chapman Marie Sinclair Paul J Gow Adam G Testro | 2020 | World Journal of Hepatology2020，12，11： | 8 |
| 10 | Non-alcoholic fatty liver disease connections with fat-free tissues: A focus on bone and skeletal muscle显示文摘The estimates of global incidence and prevalence of non-alcoholic fatty liver disease(NAFLD) are worrisome, due to the parallel burden of obesity and its metabolic complications. Indeed, excess adiposity and insulin resistance represent two of the major risk factors for NAFLD; interestingly, in the last years a growing body of evidence tended to support a novel mechanistic perspective, in which the liver is at the center of a complex interplay involving organs and systems, other than adipose tissue and glucose homeostasis. Bone and the skeletal muscle are fat- free tissues which appeared to be independently associated with NAFLD in several cross-sectional studies. The deterioration of bone mineral density and lean body mass, leading to osteoporosis and sarcopenia, respectively, are age-related processes. The prevalence of NAFLD also increases with age. Beyond physiological aging, the three conditions share some common underlying mechanisms, and their elucidations could be of paramount importance to design more effective treatment strategies for the management of NAFLD. In this review, we provide an overview on epidemiological data as well as on potential contributors to the connections of NAFLD with bone and skeletal muscle. | Eleonora Poggiogalle Lorenzo Maria Donini Andrea Lenzi Claudio Chiesa Lucia Pacifico | 2017 | World Journal of Gastroenterology2017，23，10： | 7 |
| 11 | Frailty,sarcopenia and cachexia in heart failure patients:Different clinical entities of the same painting显示文摘Heart Failure(HF)in elderly patients is a systemic syndrome where advanced age,comorbidities with organ system deterioration,frailty and impaired cognition significantly impact outcome.Cardiac cachexia,sarcopenia and frailty despite overlap in definitions are different clinical entities that frequently coexist in HF patients.However,these co-factors often remain unaddressed,resulting in poor quality-of-life,prolonged physical disability and exercise intolerance and finally with higher rehospitalization rates and mortality.Strategy aim to increase muscle mass and muscle strength and delay the occurrence of frailty state appear essential in this regard.Common HF drugs therapy(b-blockers,angiotensinconverting enzyme inhibitors)and prescription of physical exercise program remain the cornerstone of therapeutic approach in HF patients with new promising data regarding nutritional supplementation.However,the treatment of all these conditions still remain debated and only a profound knowledge of the specific mechanisms and patterns of disease progression will allow to use the appropriate therapy in a given clinical setting.For all these reasons we briefly review current knowledge on frailty,sarcopenia and cachexia in HF patients with the attempt to define clinically significant degrees of multiorgan dysfunction,specific'red alert'thresholds in clinical practice and therapeutic approach. | Matteo Beltrami Carlo Fumagalli Massimo Milli | 2021 | World Journal of Cardiology2021，13，1： | 7 |
| 12 | Sarcopenia in patients with colorectal cancer:A comprehensive review显示文摘Colorectal cancer(CRC)is the third most commonly diagnosed cancer globally and the second cancer in terms of mortality.The prevalence of sarcopenia in patients with CRC ranges between 12%-60%.Sarcopenia comes from the Greek“sarx”for flesh,and“penia”for loss.Sarcopenia is considered a phenomenon of the aging process and precedes the onset of frailty(primary sarcopenia),but sarcopenia may also result from pathogenic mechanisms and that disorder is termed secondary sarcopenia.Sarcopenia diagnosis is confirmed by the presence of low muscle quantity or quality.Three parameters need to be measured:muscle strength,muscle quantity and physical performance.The standard method to evaluate muscle mass is by analyzing the tomographic total cross-sectional area of all muscle groups at the level of lumbar 3rd vertebra.Sarcopenia may negatively impact on the postoperative outcomes of patients with colorectal cancer undergoing surgical resection.It has been described an association between sarcopenia and numerous poor short-term CRC outcomes like increased perioperative mortality,postoperative sepsis,prolonged length of stay,increased cost of care and physical disability.Sarcopenia may also negatively impact on overall survival,disease-free survival,recurrence-free survival,and cancerspecific survival in patients with non-metastatic and metastatic colorectal cancer.Furthermore,patients with sarcopenia seem prone to toxic effects during chemotherapy,requiring dose deescalations or treatment delays,which seems to reduce treatment efficacy.A multimodal approach including nutritional support(dietary intake,high energy,high protein,and omega-3 fatty acids),exercise programs and anabolic-orexigenic agents(ghrelin,anamorelin),could contribute to muscle mass preservation.Addition of sarcopenia screening to the established clinical-pathological scores for patients undergoing oncological treatment(chemotherapy,radiotherapy or surgery)seems to be the next step for the best of care of CRC patients. | Omar Vergara-Fernandez Mario Trejo-Avila Noel Salgado-Nesme | 2020 | World Journal of Clinical Cases2020，8，7： | 7 |
| 13 | Prevalence and prognostic implications of sarcopenia in older patients with coronary heart disease显示文摘Background Sarcopenia is a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes, including falls, fractures, physical disability, and mortality. However, there have been few systematic studies of the prevalence and prognostic values of sarcopenia in older patients with coronary heart disease(CHD). This study aimed to investigate the prevalence of sarcopenia in hospitalized older patients with CHD, and to prospectively evaluate the effect of sarcopenia on the short-term prognosis of these patients. Methods Patients aged ≥ 65 years, with the diagnosis of CHD from Peking Union Medical College Hospital between December 2017 and November 2018, were included. Sarcopenia was diagnosed according to consensus of the Asian Working Group for Sarcopenia in 2014. Follow-up items included unscheduled return visits, occurrence of major adverse cardiac and cerebral events (MACCE), and all-cause mortality. The MACCE-free survival curve of sarcopenic and non-sarcopenic older patients with CHD was estimated by the Kaplan-Meier method. Cox regression analysis was used to analyze the association between sarcopenia and an unscheduled return visits, MACCE, and all-cause mortality. Results A total of 345 older patients with CHD were enrolled in the study, with a median age of 74 years. Among the patients, 78 (22.6%) were diagnosed with sarcopenia. During the follow-up time, there were significantly more unscheduled return visits in sarcopenic patients than in non-sarcopenic patients (34.2% vs. 21.8%,χ^2 = 4.418, P = 0.036), while there was no significant difference in the occurrence of MACCE (χ^2 = 2.869, P = 0.09) or all-cause mortality (χ^2 = 1.673, P = 0.196) between these patient groups. The Kaplan-Meier curve showed that the MACCE-free survival time of sarcopenic patients was significantly shorter than that in non-sarcopenic patients (χ^2 = 4.102, P = 0.043). After adjusting for sex, age, and the Charlson comorbidity index, sarcopenia was not an independent risk factor of unscheduled return visits (HR = 1.002, 95% CI: 0.556–1.807). However, the complication of anxiety and depression was an independent risk factor (HR = 1.876, 95% CI: 1.012–3.477, P = 0.046) for unscheduled return visits in older patients with CHD. Conclusions There is a high prevalence of sarcopenia among hospitalized older adults with CHD. A shorter MACCE-free survival time and more unscheduled return visits are found in sarcopenic older patients with CHD. Clinicians should pay more attention to the functional status of older patients with CHD, as well as identification and management of geriatric syndromes. | Ning ZHANG Wen-Ling ZHU Xiao-Hong LIU Wei CHEN Ming-Lei ZHU Lin KANG Ran TIAN | 2019 | Journal of Geriatric Cardiology2019，16，10： | 7 |
| 14 | Association between sarcopenic obesity and higher risk of type 2 diabetes in adults: A systematic review and meta-analysis显示文摘BACKGROUND The coexistence of sarcopenia and obesity is referred to as sarcopenic obesity(SO)and it has been hypothesized that the two components of SO may synergistically increase their negative effects. However, many uncertainties still surround this condition especially with regard to its potential negative effects on health outcomes.AIM To conduct a systematic review to determine the prevalence of sarcopenia among adults with overweight and obesity and to investigate whether SO was associated with a higher risk of type 2 diabetes(T2 D).METHODS This study was conducted in adherence with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Literature searches, study selection, methodology development and quality appraisal were performed independently by two authors and the data were collated by means of metaanalysis and narrative synthesis.RESULTS Of the 606 articles retrieved, 11 studies that comprised a total of 60118 adults with overweight and obesity of both genders met the inclusion criteria and were reviewed, revealing two main findings. First, the overall prevalence of sarcopenia is 43% in females and 42% in males who are with overweight and obesity.Secondly, the presence of SO increases the risk of T2D by 38% with respect to those without SO(OR = 1.38, 95%CI: 1.27-1.50).CONCLUSION A high prevalence of sarcopenia has been found among adults with overweight and obesity regardless of their gender and this condition seems to be associatedwith a higher risk of T2D. Clinician should be aware of this scenario in their clinical practice for the better management of both obesity and T2D. | Dima Khadra Leila Itani Hana Tannir Dima Kreidieh Dana El Masri Marwan El Ghoch | 2019 | World Journal of Diabetes2019，10，5： | 6 |
| 15 | Nutritional evaluation in cirrhosis: Emphasis on the phase angle显示文摘Protein-calorie malnutrition(PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and nonanthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis(BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle(PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients' overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner. | Sabrina Alves Fernandes Angelo Alves de Mattos Cristiane Valle Tovo Claudio Augusto Marroni | 2016 | World Journal of Hepatology2016，8，29： | 6 |
| 16 | Impact of body composition on survival and morbidity after liver resection in hepatocellular carcinoma patients显示文摘Background: Hepatocellular carcinoma is the most common innate liver tumor. Due to improved surgical techniques, even extended resections are feasible, and more patients can be treated with curative intent. As the liver is the central metabolic organ, preoperative metabolic assessment is crucial for risk stratification. Sarcopenia, obesity and sarcopenic obesity characterize body composition and metabolic status. Here we present the impact of body composition on survival after liver resection in patients with hepatocellular carcinoma. Methods: A retrospective database analysis of 70 patients who were assigned for liver resection due to hepatocellular carcinoma was conducted. For assessment of sarcopenia and obesity, skeletal muscle surface area was measured at lumbar vertebra 3 level(L3) in preoperative four-phase contrast enhanced abdominal CT scans, and L3 muscle index and body fat percentage were calculated. Results: Univariate analysis comparing the survival curves using the score test demonstrated superior postoperative overall survival for sarcopenic( P = 0.035) and sarcopenic obese( P = 0.048) patients as well as a trend favoring obese( P = 0.130) subjects. Whereas multivariate analysis could not identify significant difference in postoperative survival regarding sarcopenia, obesity or sarcopenic obesity. Only large tumor size, multifocal disease and male gender were risk factors for long-term survival. Conclusions: Sarcopenia, obesity and sarcopenic obesity are indeed no risk factors for poor postoperative survival in this study. Our data do not support the evaluation of sarcopenia, obesity and sarcopenic obesity before liver resection in hepatocellular carcinoma patients. | Andreas Kroh Diane Uschner Toine Lodewick Roman M Eickhoff Wenzel Sch?ning Florian T Ulmer Ulf P Neumann Marcel Binneb?sel | 2019 | Hepatobiliary & Pancreatic Diseases International2019，18，1： | 5 |
| 17 | Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis显示文摘Minimal hepatic encephalopathy(MHE)corresponds to the earliest stage of hepatic encephalopathy(HE).MHE does not present clinically detectable neurological-psychiatric abnormalities but is characterized by imperceptible neurocognitive alterations detected during routine clinical examination via neuropsychological or psychometrical tests.MHE may affect daily activities and reduce job performance and quality of life.MHE can increase the risk of accidents and may develop into overt encephalopathy,worsening the prognosis of patients with liver cirrhosis.Despite a lack of consensus on the therapeutic indication,interest in finding novel strategies for prevention or reversion has led to numerous clinical trials;their results are the main objective of this review.Many studies address the treatment of MHE,which is mainly based on the strategies and previous management of overt HE.Current alternatives for the management of MHE include measures to maintain nutritional status while avoiding sarcopenia,and manipulation of intestinal microbiota with non-absorbable disaccharides such as lactulose,antibiotics such as rifaximin,and administration of different probiotics.This review analyzes the results of clinical studies that evaluated the effects of different treatments for MHE. | Segundo Moran Marlene López-Sánchez María del Pilar Milke-García Gustavo Rodríguez-Leal | 2021 | World Journal of Gastroenterology2021，27，22： | 5 |
| 18 | Changes in nutritional status after liver transplantation显示文摘Chronic liver disease has an important effect on nutritional status, and malnourishment is almost universally present in patients with end-stage liver disease who undergo liver transplantation. During recent decades,a trend has been reported that shows an increase in number of patients with end-stage liver disease and obesity in developed countries. The importance of carefully assessing the nutritional status during the workup of patients who are candidates for liver replacement is widely recognised. Cirrhotic patients with depleted lean body mass(sarcopenia) and fat deposits have an increased surgical risk; malnutrition may further impact morbidity, mortality and costs in the post-transplantation setting. After transplantation and liver function is restored, many metabolic alterations are corrected,dietary intake is progressively normalised, and lifestyle changes may improve physical activity. Few studies have examined the modifications in body composition that occur in liver recipients. During the first 12 mo, the fat mass progressively increases in those patients who had previously depleted body mass, and the muscle mass recovery is subtle and non-significant by the end of the first year. In some patients, unregulated weight gain may lead to obesity and may promote metabolicdisorders in the long term. Careful monitoring of nutritional changes will help identify the patients who are at risk for malnutrition or over-weight after liver transplantation. Physical and nutritional interventions must be investigated to evaluate their potential beneficial effect on body composition and muscle function after liver transplantation. | Michela Giusto Barbara Lattanzi Vincenza Di Gregorio Valerio Giannelli Cristina Lucidi Manuela Merli | 2014 | World Journal of Gastroenterology2014，20，31： | 5 |
| 19 | Sarcopenia in Chronic Liver Disease:A Metabolic Perspective显示文摘Sarcopenia,a condition of low muscle mass,quality,and strength,is commonly found in patients with chronic liver disease(CLD)and is associated with adverse clinical out-comes including reduction in quality of life,increased mor-tality,and complications.A major contributor to sarcopenia in CLD is the imbalance in muscle protein turnover wherein changes in various metabolic factors such as hyperammone-mia,amino acid deprivation,hormonal imbalance,gut dys-biosis,insulin resistance,chronic inflammation,etc.have important roles.In particular,hyperammonemia is a key mediator of the liver-gut axis and is known to contribute to sarcopenia by various mechanisms including increased ex-pression of myostatin,increased phosphorylation of eukary-otic initiation factor 2a,cataplerosis ofα-ketoglutarate,mi-tochondrial dysfunction,increased reactive oxygen species that decrease protein synthesis and increased autophagy-mediated proteolysis.Skeletal muscle is a major organ of insulin-induced glucose metabolism,and sarcopenia is closely linked to insulin resistance and metabolic syndrome.Patients with liver cirrhosis are in a hypermetabolic state that is associated with catabolism and depletion of amino acids,particularly branched-chain amino acids.Sarcopenia can have significant implications for nonalcoholic fatty liver disease,the most common form of CLD worldwide,because of the close link between metabolic syndrome and sarcope-nia.This review discusses the potential metabolic derange-ment as a cause or effect of sarcopenia in CLD,as well as interorgan crosstalk,which that might help identifying a novel therapeutic strategies. | Ramesh Kumar Sabbu Surya Prakash Rajeev Nayan Priyadarshi Utpal Anand | 2022 | Journal of Clinical and Translational Hepatology2022，10，6： | 4 |
| 20 | Impact of muscle wasting on survival in patients with liver cirrhosis显示文摘Muscle wasting is defined as the progressive and generalized loss of muscle mass. Muscle depletion is a common feature of chronic liver disease foundin approximately 40% of patients with cirrhosis. Its etiology is multifactorial subsequent to liver failure and its prevalence increases along with disease severity. Cross-sectional analytic morphometry using computed tomography(CT) scan or magnetic resonance imaging are considered by consensus the gold standards to assess muscle size in cirrhosis for research purposes because they are not biased by fluid accumulation. Several studies have assessed the impact of muscle wasting on overall survival of patients in the waiting list for liver transplantation and there is a general agreement that decreased muscle size assessed by CT scan is an independent predictor for mortality in cirrhosis. It has been proposed that the addition of cross-sectional muscle area into the Model for End-stage Liver Disease can increase its prognostic performance. Nevertheless, the use of CT scan in assessing muscle size is inappropriate for routine clinical practice and an alternative cost-effective, easy to use and accurate tool should be developed. In conclusion, muscle wasting has a detrimental impact on survival of patients with cirrhosis and, thus, it remains to be elucidated if nutritional interventions and exercise could improve muscle wasting and, subsequently, survival in this setting. | Maria Kalafateli Christos Konstantakis Konstantinos Thomopoulos Christos Triantos | 2015 | World Journal of Gastroenterology2015，21，24： | 4 |
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