Kittiprachakul Sirinda, Maung Soe Thiha, Poorirerngpoom Napalai, Srinawakul Asadapong, Numpaisarn Merint, Tiyarattanachai Thodsawit, Somlaw Nicha, Kulaputana Onanong, Ananchuensook Prooksa, Phannajit Jeerath, Rangkla Sarissa, Chaiteerakij Roongruedee
Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Eur J Clin Nutr. 2025 Sep 8. doi: 10.1038/s41430-025-01642-w.
Sarcopenia is highly prevalent and associated with poor outcomes in cirrhotic patients. We aimed to evaluate the efficacy of exercise, protein supplementation, and branched-chain amino acid (BCAA) supplementation in treating cirrhotic sarcopenia. PubMed, Embase, Scopus and the Cochrane Library were searched for randomized controlled trials of exercise, protein supplementation, and/or BCAA supplementation on improving at least one of the sarcopenia features: muscle mass, muscle strength and physical performance. Differences in post- and pre-intervention changes between intervention and control arms were calculated as a standardized mean difference (SMD), with 95% confidence interval (CI). A network meta-analysis (NMA), component NMA, pairwise meta-analysis (PW-MA) of 23 trials comprising 1525 participants were performed. By NMA, combined exercise with protein and BCAA supplementations had the greatest effect on increasing muscle mass (SMD 2.12; 95%CI: 0.59-3.65). Exercise alone or with BCAA/protein supplementation also significantly increased muscle mass, but protein or BCAA supplementation alone did not increase muscle mass. By PW-MA, exercise significantly improved physical performance versus control (SMD 1.43; 95%CI: 0.63-2.17; p < 0.01; I² = 59%) and exercise plus protein supplementation was superior to protein alone (SMD 0.66; 95%CI: 0.26-1.06; p = 0.001; I² = 0%). In the systematic review of effects of BCAA supplementation on muscle strength, its impact was inconclusive. Exercise is the mainstay of sarcopenia treatment in cirrhosis and is most effective at improving muscle mass when combined with protein and BCAA supplementation. Nutritional supplementation alone does not enhance muscle mass. Further well-designed studies are needed to identify the most effective type of exercise.
肌肉减少症在肝硬化患者中非常普遍，且与不良预后相关。我们旨在评估运动、补充蛋白质和补充支链氨基酸（BCAA）治疗肝硬化肌肉减少症的疗效。检索了PubMed、Embase、Scopus和Cochrane图书馆，查找关于运动、补充蛋白质和/或补充BCAA对改善肌肉减少症至少一项特征（肌肉量、肌肉力量和身体表现）的随机对照试验。计算干预组和对照组干预前后变化的差异作为标准化均数差（SMD），并给出95%置信区间（CI）。对23项试验（共1525名参与者）进行了网络荟萃分析（NMA）、成分NMA和配对荟萃分析（PW-MA）。通过NMA，联合运动与补充蛋白质和BCAA对增加肌肉量的效果最大（SMD 2.12；95%CI：0.59 - 3.65）。单独运动或联合补充BCAA/蛋白质也显著增加了肌肉量，但单独补充蛋白质或BCAA并未增加肌肉量。通过PW-MA，与对照组相比，运动显著改善了身体表现（SMD 1.43；95%CI：0.63 - 2.17；p < 0.01；I² = 59%），运动加补充蛋白质优于单独补充蛋白质（SMD 0.66；95%CI：0.26 - 1.06；p = 0.001；I² = 0%）。在关于补充BCAA对肌肉力量影响的系统评价中，其影响尚无定论。运动是肝硬化肌肉减少症治疗的主要手段，与补充蛋白质和BCAA联合使用时对改善肌肉量最有效。单独的营养补充并不能增加肌肉量。需要进一步设计良好的研究来确定最有效的运动类型。
