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Review
. 2020 Jul 28;21(15):5357.
doi: 10.3390/ijms21155357.

Molecular Mechanism Contributing to Malnutrition and Sarcopenia in Patients with Liver Cirrhosis

Fatuma Meyer  1 , Karen Bannert  2 , Mats Wiese  3 , Susanne Esau  1 , Lea F Sautter  1   2 , Luise Ehlers  2 , Ali A Aghdassi  3 , Cornelia C Metges  4 , Leif-A Garbe  5 , Robert Jaster  2 , Markus M Lerch  3 , Georg Lamprecht  2 , Luzia Valentini  1
Affiliations
Review

Molecular Mechanism Contributing to Malnutrition and Sarcopenia in Patients with Liver Cirrhosis

Fatuma Meyer et al. Int J Mol Sci. .

Abstract

Liver cirrhosis is frequently accompanied by disease-related malnutrition (DRM) and sarcopenia, defined as loss of skeletal muscle mass and function. DRM and sarcopenia often coexist in cirrhotic patients and are associated with increased morbidity and mortality. The clinical manifestation of both comorbidities are triggered by multifactorial mechanisms including reduced nutrient and energy intake caused by dietary restrictions, anorexia, neuroendocrine deregulation, olfactory and gustatory deficits. Maldigestion and malabsorption due to small intestinal bacterial overgrowth, pancreatic insufficiency or cholestasis may also contribute to DRM and sarcopenia. Decreased protein synthesis and increased protein degradation is the cornerstone mechanism to muscle loss, among others mediated by disease- and inflammation-mediated metabolic changes, hyperammonemia, increased myostatin and reduced human growth hormone. The concise pathophysiological mechanisms and interactions of DRM and sarcopenia in liver cirrhosis are not completely understood. Furthermore, most knowledge in this field are based on experimental models, but only few data in humans exist. This review summarizes known and proposed molecular mechanisms contributing to malnutrition and sarcopenia in liver cirrhosis and highlights remaining knowledge gaps. Since, in the prevention and treatment of DRM and sarcopenia in cirrhotic patients, more research is needed to identify potential biomarkers for diagnosis and development of targeted therapeutic strategies.

Keywords: cirrhosis; growth hormone; hyperammonemia; hypermetabolism; malnutrition; myostatin; protein turnover; sarcopenia.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Mechanisms contributing to disease-related malnutrition (DRM) and sarcopenia in liver cirrhosis.
Figure 2
Figure 2
Mechanisms specific to sarcopenia in liver cirrhosis (key mechanisms contributing to sarcopenia in liver cirrhosis are highlighted in red).
See this image and copyright information in PMC

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