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. 2022 Aug 17;14(16):3365.
doi: 10.3390/nu14163365.

The Effect of Diet and Exercise Interventions on Body Composition in Liver Cirrhosis: A Systematic Review

Heidi E Johnston  1   2 , Tahnie G Takefala  1 , Jaimon T Kelly  3   4 , Shelley E Keating  5 , Jeff S Coombes  5 , Graeme A Macdonald  2   6 , Ingrid J Hickman  1   2 , Hannah L Mayr  1   2   7   8
Affiliations

The Effect of Diet and Exercise Interventions on Body Composition in Liver Cirrhosis: A Systematic Review

Heidi E Johnston et al. Nutrients. .

Abstract

Alterations in body composition, in particular sarcopenia and sarcopenic obesity, are complications of liver cirrhosis associated with adverse outcomes. This systematic review aimed to evaluate the effect of diet and/or exercise interventions on body composition (muscle or fat) in adults with cirrhosis. Five databases were searched from inception to November 2021. Controlled trials of diet and/or exercise reporting at least one body composition measure were included. Single-arm interventions were included if guideline-recommended measures were used (computed tomography/magnetic resonance imaging, dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or ultrasound). A total of 22 controlled trials and 5 single-arm interventions were included. Study quality varied (moderate to high risk of bias), mainly due to lack of blinding. Generally, sample sizes were small (n = 6-120). Only one study targeted weight loss in an overweight population. When guideline-recommended measures of body composition were used, the largest improvements occurred with combined diet and exercise interventions. These mostly employed high protein diets with aerobic and or resistance exercises for at least 8 weeks. Benefits were also observed with supplementary branched-chain amino acids. While body composition in cirrhosis may improve with diet and exercise prescription, suitably powered RCTs of combined interventions, targeting overweight/obese populations, and using guideline-recommended body composition measures are needed to clarify if sarcopenia/sarcopenic obesity is modifiable in patients with cirrhosis.

Keywords: body composition; exercise; liver cirrhosis; nutrition; sarcopenia; sarcopenic obesity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of the study selection process.
Figure 2
Figure 2
Risk of bias summaries for RCTs using Cochrane Risk of Bias 2 Tool [33,34,35,36,37,38,39,40,41,44,45,47,48,50,51,54,55,56,57].
Figure 3
Figure 3
Risk of bias summaries for non-RCTs using Cochrane ROBINS-I (risk of bias tool to assess non-randomised studies of interventions) [32,42,43,52,53,56,58,59].
See this image and copyright information in PMC

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