Sarcopenia is the loss of muscle mass and function, affecting up to 70% of patients with advanced
liver disease. Liver cirrhosis is characterized by an altered glucose metabolism, lipid oxidation,
ketogenesis and protein catabolism, leading to the loss of adipose and muscle tissue. The gastrointestinal
dysfunction of cirrhotic patients results in inadequate nutrients intake and is responsible for muscle
weakness thus limiting physical exercise and perpetuating the reduction of muscle mass. Recently, alterations
of hormonal pathways involved in muscle growth, increased intestinal permeability and changes in
the gut microbiota composition have been reported in cirrhotic patients. Interestingly, a role of intestinal
bacteria in maintaining muscle health has been hypothesized through the translocation of bacteria and
bacterial products into the bloodstream triggering the production of muscle wasting-related cytokines.
Sarcopenia is associated with severe outcomes in patients with liver cirrhosis, mostly due to the incidence
of disease complications. Furthermore, sarcopenia may represent an important prognostic factor for patients
with hepatocellular carcinoma and for those undergoing liver transplantation and can be considered
a useful additional tool in the global assessment of patients with advanced liver disease.
Keywords: Sarcopenia, liver cirrhosis, liver disease, gut microbiota, malnutrition, liver transplantation, intestinal permeability.
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