Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7357-7361
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7357
Impact of muscle wasting on survival in patients with liver cirrhosis
Maria Kalafateli, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos
Maria Kalafateli, Christos Konstantakis, Konstantinos Thomopoulos, Christos Triantos, Department of Gastroenterology, University Hospital of Patras, 26504 Patras, Greece
Author contributions: Triantos C and Kalafateli M conceptualized and designed this editorial; Kalafateli M, Konstantakis C and Triantos C reviewed the literature and wrote the manuscript; Thomopoulos K reviewed the manuscript critically for important intellectual content; all authors approved the final version of the manuscript.
Conflict-of-interest: Dr Triantos has received fees for serving as a speaker for Bristol-Myers Squibb and Gilead.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christos Triantos, MD, Department of Gastroenterology, University Hospital of Patras, Stamatopoulou 4, Rio, 26504 Patras, Greece. chtriantos@hotmail.com
Telephone: +30-697-2894651 Fax: +30-261-0625382
Received: December 23, 2014
Peer-review started: December 25, 2014
First decision: March 10, 2015
Revised: March 26, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: June 28, 2015
Processing time: 187 Days and 21.9 Hours
Abstract

Muscle wasting is defined as the progressive and generalized loss of muscle mass. Muscle depletion is a common feature of chronic liver disease found in approximately 40% of patients with cirrhosis. Its etiology is multifactorial subsequent to liver failure and its prevalence increases along with disease severity. Cross-sectional analytic morphometry using computed tomography (CT) scan or magnetic resonance imaging are considered by consensus the gold standards to assess muscle size in cirrhosis for research purposes because they are not biased by fluid accumulation. Several studies have assessed the impact of muscle wasting on overall survival of patients in the waiting list for liver transplantation and there is a general agreement that decreased muscle size assessed by CT scan is an independent predictor for mortality in cirrhosis. It has been proposed that the addition of cross-sectional muscle area into the Model for End-stage Liver Disease can increase its prognostic performance. Nevertheless, the use of CT scan in assessing muscle size is inappropriate for routine clinical practice and an alternative cost-effective, easy to use and accurate tool should be developed. In conclusion, muscle wasting has a detrimental impact on survival of patients with cirrhosis and, thus, it remains to be elucidated if nutritional interventions and exercise could improve muscle wasting and, subsequently, survival in this setting.

Keywords: Cirrhosis; Sarcopenia; Malnutrition; Survival; Muscle wasting

Core tip: Malnutrition is a common feature of cirrhosis and its detrimental impact on the survival of these patients has been early recognized. Malnutrition is not synonymous to muscle wasting but there is a great overlap between them with malnutrition to be significantly associated with muscle depletion. Muscle wasting assessed by using the computed tomography cross-sectional area of skeletal muscles at the level of the third lumbar vertebra has been found to be independently associated with mortality. The hypothesis that nutritional interventions and exercise aiming to correct muscle depletion could possibly improve the survival of patients with cirrhosis needs to be further investigated.