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Review
. 2019 Jan-Feb;9(1):125-130.
doi: 10.1016/j.jceh.2018.04.007. Epub 2018 May 5.

Hepatic Encephalopathy and Sarcopenia: Two Faces of the Same Metabolic Alteration

Barbara Lattanzi  1 , Daria D'Ambrosio  1 , Manuela Merli  1
Affiliations
Review

Hepatic Encephalopathy and Sarcopenia: Two Faces of the Same Metabolic Alteration

Barbara Lattanzi et al. J Clin Exp Hepatol. 2019 Jan-Feb.

Abstract

Sarcopenia is an important burden in liver cirrhosis representing a negative prognostic factor for mortality. Moreover, sarcopenia is an independent predictor of complications in patients with liver cirrhosis, including Hepatic Encephalopathy (HE). An association between sarcopenia and HE in liver cirrhosis has been reported in recent studies, indeed both these complications often affect patients with advanced liver cirrhosis and may exert a synergic effect in deteriorating patients' outcome. Episodes of HE occur more often in patients with muscle depletion. The rationale for these finding is based on the role played by muscle in ammonia detoxification due to the inability of urea synthesis in the cirrhotic liver. Consequently, muscle depletion may have relevant implications in favoring hyperammonemia and HE. At the same time hyperammonemia has been found to impair muscle protein synthesis through myostatin down-regulation. From this point of view, modulation of diet and amelioration of nutritional status and muscle mass can be considered a potential goal to prevent this vicious circle and improve the cognitive impairment in cirrhotic patients.

Keywords: BCAA, Branched Chain Amino Acids; CT, Computed Tomography; HE, Hepatic Encephalopathy; MELD, Model for End-stage Liver Disease; MHE, Minimal Hepatic Encephalopathy; TIPS, Transjugular Intrahepatic Portosystemic Shunt; hepatic encephalopaty; malnutrition; sarcopenia.

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Figures

Figure 1
Figure 1
The ammonia metabolism and trafficking in liver cirrhosis.
See this image and copyright information in PMC

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