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

doi:10.4254/wjh.v15.i5.649

Sarcopenia in chronic viral hepatitis: From concept to clinical relevance

World J Hepatol. 2023 May 27;15(5):649-665. doi: 10.4254/wjh.v15.i5.649.

Authors

Marta Paula Pereira Coelho¹, Pedro Alves Soares Vaz de Castro², Thaís Pontello de Vries¹, Enrico Antônio Colosimo³, Juliana Maria Trindade Bezerra^{4

5}, Gifone Aguiar Rocha⁶, Luciana Diniz Silva⁷

Affiliations

¹ Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil.
² Medical Undergraduate Student, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil.
³ Department of Statistics, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil.
⁴ Department of Biological Sciences, Universidade Estadual do Maranhão, Açailândia 65715-000, Maranhão, Brazil.
⁵ Post-Graduate Programme of Animal Science, Universidade Estadual do Maranhão, São Luiz do Maranhão 65.055-310, Maranhão, Brazil.
⁶ Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil.
⁷ Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil. lucianadinizsilva@gmail.com.

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; Cirrhosis; Clinical outcomes; Sarcopenia; Skeletal muscle loss.

Publication types

Review