Muscle and Mortality in Cirrhosis

Published:November 11, 2011DOI:
      Skeletal muscle wasting, accompanied by weakness and poor functional capacity, is a frequent finding in advanced liver disease. Many factors contribute to cachexia in cirrhosis. Loss of appetite is common and might be related to metabolic and hormonal alterations, medications, hepatic encephalopathy, or inflammatory cytokines. Poor diet is frequent in cirrhotic patients with active alcoholism and substance abuse and might be aggravated by poverty, poor social support, and iatrogenic restrictions. Postprandial discomfort associated with tense ascites might limit oral intake. Impaired gut motility with small intestinal bacterial overgrowth might contribute to altered digestion and nutrient malabsorption. Cirrhosis is a hypermetabolic state, increasing demand for calories and protein. The cirrhotic liver has reduced gluconeogenic capacity, and relatively short periods of fasting in cirrhotic patients lead to muscle breakdown with mobilization of skeletal muscle amino acids (Figure 1) .
      Figure thumbnail gr1
      Figure 1Causes of diminished muscle mass in cirrhosis.
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