«CONCLUSION: Substantial data exist clearly demonstrating that PEM confers a risk of poor survival in LC patients. PEM in LC patients is highly associated with sarcopenia and a decrease in serum albumin levels. These conditions have also been reported to be predictors of poor patient survival. Nutrition and exercise management can improve PEM and sarcopenia in LC patients. Nutrition management includes sufficient dietary intake and an improvement of impaired nutrient metabolism. In contrast, the current rise in obesity prevalence has increased the number of obese LC patients. Restriction of excessive caloric intake without exacerbation of impaired nutrient metabolism is necessary for those patients. BCAAs are good candidates for supplemental nutrients for both obese and non-obese LC patients. Exercise management can increase skeletal muscle volume and strength and can improve insulin resistance; however, assessment of nutritional status and LC complications is mandatory before the implementation of an exercise program for LC patients. The establishment of optimal exercise regimens for LC patients is required. The further development of methods for nutrition and exercise management will improve the overall health outcomes of LC patients.»
"The timing of dietary intake can influence energy metabolism. Because LC patients are prone to entering a starvation state after a relatively short fasting period, a large number of small meals (“nibbling” pattern) rather than a small number of large meals (“gorging” pattern) is considered preferable to maintain optimal energy metabolism"
"Because LC patients have decreased gluconeogenesis ability and glycogen stores capacity, they are prone to entering into a starvation state after a relatively short fasting period (e.g., overnight). In this situation, lipid metabolism is enhanced; energy metabolism shifts from a carbohydrate preference to lipid oxidation preference"
"Because albumin synthesis is decreased in LC patients, serum albumin levels inversely correlate with the grade of liver dysfunction. Furthermore, in a study of compensated LC patients with alanine aminotransferase levels > 50 IU/L, a positive correlation between serum albumin
levels and skeletal muscle
volume was observed. LC-associated PEM accelerates protein catabolism
, which is the overall breakdown of cellular proteins
, mainly in skeletal muscle
, and which provides amino acids, especially branched chain amino acids (BCAA
), for protein synthesis
and energy supply[39-41]. BCAA
consist of leucine
, isoleucine, and valine."