Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia.
Nutrients. 2022 Aug 17;14(16):3365. doi: 10.3390/nu14163365.
Alterations in body composition, in particular sarcopenia and sarcopenic obesity, are complications of liver cirrhosis associated with adverse outcomes. This systematic review aimed to evaluate the effect of diet and/or exercise interventions on body composition (muscle or fat) in adults with cirrhosis. Five databases were searched from inception to November 2021. Controlled trials of diet and/or exercise reporting at least one body composition measure were included. Single-arm interventions were included if guideline-recommended measures were used (computed tomography/magnetic resonance imaging, dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or ultrasound). A total of 22 controlled trials and 5 single-arm interventions were included. Study quality varied (moderate to high risk of bias), mainly due to lack of blinding. Generally, sample sizes were small ( = 6-120). Only one study targeted weight loss in an overweight population. When guideline-recommended measures of body composition were used, the largest improvements occurred with combined diet and exercise interventions. These mostly employed high protein diets with aerobic and or resistance exercises for at least 8 weeks. Benefits were also observed with supplementary branched-chain amino acids. While body composition in cirrhosis may improve with diet and exercise prescription, suitably powered RCTs of combined interventions, targeting overweight/obese populations, and using guideline-recommended body composition measures are needed to clarify if sarcopenia/sarcopenic obesity is modifiable in patients with cirrhosis.
身体成分的改变，特别是肌肉减少症和肌肉减少性肥胖症，是与不良结局相关的肝硬化并发症。本系统评价旨在评估饮食和/或运动干预对肝硬化成人身体成分（肌肉或脂肪）的影响。从创建到 2021 年 11 月，对五个数据库进行了搜索。纳入了至少报告一项身体成分测量值的饮食和/或运动对照试验。如果使用了指南推荐的措施（计算机断层扫描/磁共振成像、双能 X 射线吸收法、生物电阻抗分析或超声），则纳入单臂干预。共纳入 22 项对照试验和 5 项单臂干预。研究质量存在差异（偏倚风险为中度至高度），主要是由于缺乏盲法。通常，样本量较小（=6-120）。只有一项研究针对超重人群的体重减轻。当使用身体成分的指南推荐措施时，联合饮食和运动干预的效果最大。这些措施主要采用高蛋白饮食，并进行至少 8 周的有氧运动和/或抗阻运动。补充支链氨基酸也观察到了益处。虽然饮食和运动处方可能会改善肝硬化患者的身体成分，但需要进行适当规模的 RCT，针对超重/肥胖人群，并使用指南推荐的身体成分测量方法，以明确肝硬化患者的肌少症/肌少性肥胖症是否可以改变。
