Interventions to improve sarcopenia in cirrhosis: A systematic review

Table 1 Nutritional interventions to improve sarcopenia in cirrhosis

Ref.	Study participant’s characteristics	Study design	Sample size	Intervention	Duration of intervention	Diagnosis of sarcopenia	Results
Marchesini et al[29], 2003	mean age: 59 yr; males/females: 13/59; BMI: NA; CTP score: 9; setting: Europe	RCT	174	Intervention: Nutritional supplementation with BCCA (leucine, isoleucine and valine); Control: Lactalbumin or maltodextrins	1 yr	Anthropometric and BIA	Significant increase in triceps skinfold thickness and MA fat area
Okumara et al[30], 2006	Age: NA; Gender: NA; mean BMI: 21; CTP score: 6; setting: Japan	Case control	47	Regular diet and late evening snack (rice ball)	1 wk	Anthropometric measurement i.e., AMA, AC and AMC	No significant differences in BMI, AC, AMC or AMA; improvement in RQ value in intervention group
Nakaya et al[31], 2007	Age: 67; males/females: 20/18; mean BMI: 22.9; CTP score: 7; setting: Japan	RCT	48	LES with BCAA enriched mixture or ordinary food such as rice ball or bread	3 mo	Anthropometric measurements such as MAC and triceps skin fold thickness	No significant improvement in the anthropometric parameter in either group
Les et al[32], 2011	mean age: 64.1 ± 10.4; males/females: 88/28; mean BMI: NA; CTP score: 8; Setting: Barcelona	RCT	116	Intervention: Standard diet + 0.7 g of protein/kg + supplement of 30 g of BCAA; Control group: Standard diet + 0.7 g of protein/kg + maltodextrin	56 wk	Anthropometric	Increased in MA circumference and hand grip in intervention group
Sorrentino et al[33], 2012	mean age: 65; males/females: 81/39; mean BMI: NA; CTP score: 12; setting: Italy	RCT	120	Group A: parenteral nutritional support + balanced diet + LES; Group B: balanced diet + LES; Group C: low sodium or sodium free diet	12 mo	Anthropometric measurements such as MAC and triceps skin fold thickness	No significant differences in the anthropometric measures in three groups. Significantly improved in the morbidity and mortality in group A and B
Dupont et al[34], 2012	mean age: 54.6 ± 9.6; males/females: 65/43; mean BMI: 26; CTP score: 10; setting: France	RCT	99	Enteral nutrition vs a symptomatic support; i.e., 30–35 kcal/kg per day of a polymeric solution for a period of 3–4 wk, through a nasogastric feeding tube. for three oral nutritional supplements per day for 2 mo.	3 mo	Anthropometric measurements such as MAC and triceps skin fold thickness	No change in arm muscle circumference
Maharshi et al[35], 2016	mean age: 42; males/females: 5/25; mean BMI: NA; CTP score: 8; setting: India	RCT	120	Nutritional therapy (30-35 kcal/kg/d, 1.0-1.5 g vegetable protein/kg/d vs no nutritional therapy	6 mo	Anthropometric measurements such as MAC and triceps skin fold thickness	Significant improvement in the MAC, hand grip and skeletal muscle mass
Ruiz-Margain et al[36], 2017	mean age: 47.8-54.9; males/females: 13/59; mean BMI: 26; CTP score: 6; setting: Mexico	RCT	72	Intervention: BCAA + High protein and high fiber diet; Control: Only high protein and high fiber diet	6 mo	Anthropometric measurement: triceps skin fold thickness and MAC	Increase in muscle and decrease in fat mass in intervention group
Kitajima et al[37], 2017	mean age: 71.3 ± 7.9; males/females: 9/12; mean BMI: 23.9; CTP score: NA; setting: Japan	Longitudinal study; (pre-post intervention)	21	Diet supplemented with BCAA 3 x daily after meals	48 wk	CT scan and BIA	ΔIMAC and ΔSAI significantly correlated with Δserum albumin level. BCAA supplementation prevented the progression of sarcopenia in cirrhosis
Ohara et al[38], 2018	mean age: 67; males/females: 53/17; mean BMI: 24.6; CTP score: 7; setting: Japan	Matched case control; Cases: 35; Control: 35	70	Cases: Received L carnitine; Control: no supplementation	6 mo	CT images: Psoas muscle index	Significant suppression in the loss of skeletal muscle in intervention group

MA: Mid arm fat area; BIA: Bio impedance analysis; AMA: Arm muscle area; AC: Mid upper arm circumference; AMC: Arm muscle circumference; RQ: Respiratory quotient; BMI: Body mass index.