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World J Hepatol. May 27, 2023; 15(5): 649-665
Published online May 27, 2023. doi: 10.4254/wjh.v15.i5.649
Sarcopenia in chronic viral hepatitis: From concept to clinical relevance
Marta Paula Pereira Coelho, Pedro Alves Soares Vaz de Castro, Thaís Pontello de Vries, Enrico Antônio Colosimo, Juliana Maria Trindade Bezerra, Gifone Aguiar Rocha, Luciana Diniz Silva
Marta Paula Pereira Coelho, Thaís Pontello de Vries, Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Pedro Alves Soares Vaz de Castro, Medical Undergraduate Student, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Enrico Antônio Colosimo, Department of Statistics, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Juliana Maria Trindade Bezerra, Department of Biological Sciences, Universidade Estadual do Maranhão, Açailândia 65715-000, Maranhão, Brazil
Juliana Maria Trindade Bezerra, Post-Graduate Programme of Animal Science, Universidade Estadual do Maranhão, São Luiz do Maranhão 65.055-310, Maranhão, Brazil
Gifone Aguiar Rocha, Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Luciana Diniz Silva, Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Author contributions: Silva LD wrote the majority of the manuscript and prepared the figures and tables; Silva LD, Coelho MPP, Castro PASV, and Vries TP performed data acquisition and writing; Colosimo EA and Bezerra JMT provided inputs for writing the paper; Rocha GA designed the outline and coordinated the writing of the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other co-authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luciana Diniz Silva, MD, Associate Professor, Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av Alfredo Balena 190 s/245, Belo Horizonte 30130-100, Minas Gerais, Brazil. lucianadinizsilva@gmail.com
Received: December 31, 2022
Peer-review started: December 31, 2022
First decision: January 30, 2023
Revised: February 17, 2023
Accepted: April 6, 2023
Article in press: April 6, 2023
Published online: May 27, 2023
Abstract

Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma (HCC) is increasing, chronic hepatitis B (CHB) and chronic hepatitis C (CHC) remain the most relevant risk factors for advanced liver disease worldwide. In addition to liver damage, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia, lymphoproliferative disorders, renal disease, insulin resistance, type 2 diabetes, sicca syndrome, rheumatoid arthritis-like polyarthritis, and autoantibody production. Recently, the list has grown to include sarcopenia. Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0% of patients with advanced liver disease. Nonetheless, among published studies, there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia. In particular, the interaction between sarcopenia, CHB and CHC has not been completely clarified in a real-world setting. Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV. Thus, in the present review, we provide an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis, with an emphasis on clinical outcomes, which have been associated with skeletal muscle loss in these patients. A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV, independent of the stage of the liver disease, will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.

Keywords: Chronic hepatitis B, Chronic hepatitis C, Sarcopenia, Skeletal muscle loss, Cirrhosis, Clinical outcomes

Core Tip: Sarcopenia is a key feature of malnutrition in liver cirrhosis and has been found in approximately 23.0%-60.0% of patients with advanced hepatic disease. Skeletal muscle loss is associated with poor quality of life and increased mortality, which are significant cirrhosis-related complications. In individuals chronically infected with hepatitis B virus or hepatitis C virus, the muscle-liver-immune crosstalk during the development of sarcopenia has not been completely clarified. Based on these findings, an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis is of utmost importance.