The role of physical exercise and nutrition in the preventation of muscle mass in patients with decompensated cirrhosis

Purpose: Sarcopenia, which has a high prevalence in liver cirrhosis, increases other cirrhosis complications in patients, reduces quality of life and survival, and negatively affects prognosis after transplantation. In our study, we aimed to investigate the role of physical exercise and nutrition in preventing muscle mass in decompansated cirrhosis. Introduction: Sarcopenia is defined as loss of muscle mass and function and is a common complication in decompensated cirrhosis, as well as a factor that negatively affects prognosis. The gold standard method for diagnosis is computed tomography. Method: To achieve this, 31 patients with decompensated liver cirrhosis were included in a prospective, randomized clinical study with uncontrolled ascites, uncontrolled bleeding and MELD≥15, hepatocellular cancer, other malignancies, GFR<60 ml/min, uncontrolled DM, were excluded. After excluding those with uncontrolled pulmonary insufficiency and uncontrolled heart failure, they were randomized into two groups. During a 3-month period, the treatment group was given diet and resistance exercise, and the control group was given diet and placebo exercise. At the beginning of the study and at the 12th week, patients were evaluated using anthropometric (body mass index, mid-upper arm circumference, mid-thigh circumference, triceps subcutaneous thickness) measurements, laboratory analyses, questionnaires (subjective global assessment, fatigue severity scale, Berg-balance analysis), hand grip strenght test, 6-minute walk test, and upper abdominal tomography (CT). Findings: When the 1st and 2nd measurements were compared in the active exercise and passive exercise groups, MELD Na increased significantly in the 12th week compared to the baseline in the control group (p=0.048). Prealbumin value increased significantly in the second measurement as in the control group (p=0.029). The INR value decreased significantly in the active exercise group at the 12th week (p=0.013). The initial and 12th week values of patients with decompensated cirrhosis were compared separately in both groups, and weight and BMI were found to be significantly higher than the initial value in the control group (p=0.017, p=0.018, respectively). In addition, the 6-minute walk test increased significantly in patients compared to the initial levels in both the active exercise and passive exercise groups (p=0.027, p=0.036, respectively). The rate of those with SGA A in the active exercise group increased from 28.6% to 54.6% after 3 months. It was observed that the SGA level of only one person (6.25%) in the passive exercise group changed positively, from SGA B + sarcopenia + cachexia to SGA A + sarcopenia. Results: Resistance exercise; although there is no objective data, it increased muscle strength and muscle mass and improved SGA result and INR. 6-minute walk test, fatigue severity scale, Berg-balance test and prealbumin changed positively in both groups. In addition, no HES symptoms were observed in any patient during the study. Key words: Sarcopenia, skeletal muscle index, decompensated cirrhosis