Interventions to improve sarcopenia in cirrhosis: A systematic review

Table 3 Combined life style intervention (exercise and nutrition) to improve sarcopenia in cirrhosis

Ref.	Study participants characteristics	Study design	Sample size	Intervention	Duration of intervention	Diagnosis of sarcopenia	Results
Roman et al[44], 2014	mean age: 43-75; males/females: 12/5; mean BMI: 27; CTP score: 7; setting: Spain	RCT	17	Intervention: moderate exercise + oral leucine; Control: Placebo	12 wk	Exercise capacity (6-min walk and 2-min step tests), anthropometric measurement	Significant increase in exercise capacity. Increase in lower thigh circumference. No changes in control group
Nishida et al[45], 2017 (medium risk)	mean age: 47.8-54.9; gender: 6 females; mean BMI: 24.3; CTP score: 6; setting: Japan	Quasi experimental (pre-post intervention)	6	Homes based step exercise at AT (140 min/wk) and BCAA supplementation (12.45 g/d)	12 mo	CT scan to assess fat deposition in liver and IMAC	Significantly increased AT; No changes in TBW, liver/spleen ratio or IMAC
Hiraoka et al[46], 2017	median age (IQR): 66 (62-70); males/females: 13/20; child A/B: 30/3; median BMI (IQR): 23.2 (20.8-25.1); setting: Japan	Quasi experimental (pre-post intervention)	33	BCAA supplementation as LES and additional 2000 steps/d prescribed	6 mo	BIA Leg and Hand grip	Muscle volume, leg and handgrip strength increased after post intervention
Berzigotti et al[47], 2017	mean age: 56 ± 8; gender: 31/29; mean BMI: 33; CTP score: < 8; setting: Spain	Quasi experimental (pre-post intervention)	60 included and 50 completed the study	LS interventions which include: Reduce calorie intake of 500-1000 kCal/d (protein intake 20%-25%, Carbs: 45%-50% and fat content < 35%); Supervised exercise-60 min session of moderate exercise.	16 wk	BIA and anthropometric measurements	Decrease in TBW, fat mass; Unchanged lean mass

AT: Anaerobic threshold; IMAC: Intramuscular adipose tissue content; BMI: Body mass index.