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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Interventions to improve sarcopenia in cirrhosis: A systematic review
Maliha Naseer, Erica P Turse, Ali Syed, Francis E Dailey, Mallak Zatreh, Veysel Tahan
Maliha Naseer, Department of Internal Medicine, Division of Gastroenterology and Hepatology, East Carolina University, Greenville, NC 27834, United States
Erica P Turse, Department of Internal Medicine, Division of Gastroenterology, St Joseph Hospital Medical Center/Creighton University, Phoenix, AZ 85013, United States
Ali Syed, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
Francis E Dailey, Mallak Zatreh, Veysel Tahan, Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
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/
Corresponding author: Veysel Tahan, FACG, FACP, FESBGH, MD, Assistant Professor, Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, One Hospital Drive, CD 405, Columbia, MO 65212, United States. tahanv@health.missouri.edu
Telephone: +1-573-8846044 Fax: +1-573-8844595
Received: October 18, 2018
Peer-review started: October 18, 2018
First decision: November 29, 2018
Revised: December 10, 2018
Accepted: December 12, 2018
Article in press: December 12, 2018
Published online: January 26, 2019
Processing time: 100 Days and 12.8 Hours
ARTICLE HIGHLIGHTS
Research background
Sarcopenia, i.e., muscle loss is now a well-recognized complication of cirrhosis; and in cases of non-alcoholic fatty liver disease, it can contribute to accelerate liver fibrosis leading to cirrhosis.
Research motivation
It is imperative to study interventions which targets to improve sarcopenia in cirrhosis.
Research objectives
Aim of this systematic review of the literature was to examine the relationship between interventions and trans jugular intrahepatic portosystemic shunt (TIPS) to improve muscle mass in cirrhosis.
Research methods
We search PubMed, EMBASE and Cochrane between June-August 2018, without a limiting period and the types of articles in adult patients with sarcopenia and cirrhosis. The primary outcome of interest was improvement in muscle mass, strength and physical function interventions mentioned above.
Research results
Twenty four studies that met review inclusion criteria were identified. The studies were diverse in terms of the design, setting, interventions, and outcome measurements. Only qualitative synthesis of evidence due to heterogeneity amongst studies was performed. Risk of bias was medium in most of the included studies, and low quality of evidence showed improvement in the muscle mass, strength and physical function following aerobic exercise. There are 60% of the included studies on the nutritional intervention, 100% of the studies on testosterone replacement in hypogonadal men and trans-jugular portosystemic shunt were proved to be effective in improving sarcopenia in cirrhosis.
Research conclusions
Although the quality of evidence is low, the findings of this systematic review suggest improvement in the sarcopenia in cirrhosis with exercise, nutritional interventions, hormonal and TIPS interventions.
Research perspectives
High quality randomized controlled trials are needed to further strengthen these findings.
