{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:51:05Z","timestamp":1792792265051,"version":"4.5.0"},"reference-count":88,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["2025-16069136"],"award-info":[{"award-number":["2025-16069136"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Malnutrition, sarcopenia, and frailty are highly prevalent in patients with chronic liver disease and are closely associated with poor clinical outcomes. This review highlights the complex interplay between macronutrient metabolism and muscle wasting in liver cirrhosis. We explore the alterations in glucose, lipid, and amino acid metabolism that occur in cirrhosis, including the role of skeletal muscle in compensatory ammonia detoxification. The review also discusses the emerging evidence on sarcopenia as a prognostic marker and therapeutic target, with a focus on the role of branched-chain amino acid (BCAA) supplementation. While several studies have demonstrated the clinical benefits of BCAA in improving muscle mass, hepatic encephalopathy, and quality of life, results remain mixed, emphasizing the need for further well-designed clinical trials. Understanding the muscle\u2013liver\u2013gut axis may offer novel insights into therapeutic strategies for managing sarcopenia in liver disease.<\/jats:p>","DOI":"10.3390\/nu17213346","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T07:31:58Z","timestamp":1761550318000},"page":"3346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Protein and Macronutrient Metabolism in Liver Cirrhosis: About Sarcopenia"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8294-3517","authenticated-orcid":false,"given":"Seul Ki","family":"Han","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"},{"name":"Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"},{"name":"Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6245-2537","authenticated-orcid":false,"given":"Soon Koo","family":"Baik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"},{"name":"Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"},{"name":"Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2501-2206","authenticated-orcid":false,"given":"Moon Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"},{"name":"Regenerative Medicine Research Center, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"},{"name":"Cell Therapy and Tissue Engineering Center, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/jcsm.12039","article-title":"Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis","volume":"7","author":"Angulo","year":"2016","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1097\/MCG.0000000000001109","article-title":"Pretransplant Sarcopenia in Patients with NASH Cirrhosis Does Not Impact Rehospitalization or Mortality","volume":"53","author":"Aby","year":"2019","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1111\/apt.15161","article-title":"The evolution and impact of sarcopenia pre- and post-liver transplantation","volume":"49","author":"Bhanji","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s00535-020-01711-w","article-title":"Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments","volume":"55","author":"Marasco","year":"2020","journal-title":"J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1002\/jcsm.12333","article-title":"Impact of sarcopenia on prognostic value of cirrhosis: Going beyond the hepatic venous pressure gradient and MELD score","volume":"9","author":"Kang","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1002\/hep.32049","article-title":"Malnutrition, Frailty, and Sarcopenia in Patients with Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Lai","year":"2021","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1002\/hep.1840170407","article-title":"A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: Results of a Department of Veterans Affairs cooperative study","volume":"17","author":"Mendenhall","year":"1993","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1053\/gast.2001.21193","article-title":"Factors associated with poor health-related quality of life of patients with cirrhosis","volume":"120","author":"Marchesini","year":"2001","journal-title":"Gastroenterology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3533","DOI":"10.1016\/j.clnu.2020.09.001","article-title":"ESPEN practical guideline: Clinical nutrition in liver disease","volume":"39","author":"Bischoff","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/hep.31884","article-title":"Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Biggins","year":"2021","journal-title":"Hepatology"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Llibre-Nieto, G., Lira, A., Vergara, M., Sole, C., Casas, M., Puig-Divi, V., Sole, G., Humanes, A., Grau, L., and Barradas, J.M. (2021). Micronutrient Deficiencies in Patients with Decompensated Liver Cirrhosis. Nutrients, 13.","DOI":"10.3390\/nu13041249"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3350\/cmh.2019.0015","article-title":"Sarcopenia: Ammonia metabolism and hepatic encephalopathy","volume":"25","author":"Jindal","year":"2019","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1056\/NEJMra070553","article-title":"Vitamin D deficiency","volume":"357","author":"Holick","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2019.11.009","article-title":"Zinc and protein metabolism in chronic liver diseases","volume":"74","author":"Katayama","year":"2020","journal-title":"Nutr. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Souza, A.C.R., Vasconcelos, A.R., Dias, D.D., Komoni, G., and Name, J.J. (2023). The Integral Role of Magnesium in Muscle Integrity and Aging: A Comprehensive Review. Nutrients, 15.","DOI":"10.3390\/nu15245127"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Yoon, S.J., Han, S.K., Kim, T.S., Suk, K.T., Choi, D.H., Kim, Y.D., Kim, M.Y., Cheon, G.J., Baik, S.K., and Kim, D.J. (2025). The crosstalk between gut microbiota and microbiota-derived metabolites in hepatocellular carcinoma. Crit. Rev. Microbiol., 1\u201315.","DOI":"10.1080\/1040841X.2025.2501590"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jhep.2004.03.023","article-title":"Normal protein diet for episodic hepatic encephalopathy: Results of a randomized study","volume":"41","author":"Cordoba","year":"2004","journal-title":"J. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1053\/j.gastro.2015.12.038","article-title":"Intensive Enteral Nutrition Is Ineffective for Patients with Severe Alcoholic Hepatitis Treated with Corticosteroids","volume":"150","author":"Moreno","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/jgh.14665","article-title":"Significant effects of late evening snack on liver functions in patients with liver cirrhosis: A meta-analysis of randomized controlled trials","volume":"34","author":"Chen","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"9189062","DOI":"10.1155\/2018\/9189062","article-title":"Effects of Late Evening Snack on Cirrhotic Patients: A Systematic Review and Meta-Analysis","volume":"2018","author":"Guo","year":"2018","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver Research (2019). EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J. Hepatol., 70, 172\u2013193.","DOI":"10.1016\/j.jhep.2018.06.024"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1002\/lt.25602","article-title":"Nutritional Assessment in Inpatients with Cirrhosis Can Be Improved After Training and Is Associated with Lower Readmissions","volume":"25","author":"Reuter","year":"2019","journal-title":"Liver Transpl."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/apt.12252","article-title":"Meta-analysis: Oral or enteral nutritional supplementation in cirrhosis","volume":"37","author":"Ney","year":"2013","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.cld.2011.12.009","article-title":"Malnutrition in cirrhosis: Contribution and consequences of sarcopenia on metabolic and clinical responses","volume":"16","author":"Periyalwar","year":"2012","journal-title":"Clin. Liver Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e218","DOI":"10.1038\/emm.2015.122","article-title":"Regulation of glucose metabolism from a liver-centric perspective","volume":"48","author":"Han","year":"2016","journal-title":"Exp. Mol. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3350\/cmh.2025.0048","article-title":"Role of amino acids in the regulation of hepatic gluconeogenesis and lipogenesis in metabolic dysfunctionassociated steatotic liver disease","volume":"31","author":"Kakazu","year":"2025","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"101820","DOI":"10.1016\/j.xcrm.2024.101820","article-title":"Hepatic glucose production rises with the histological severity of metabolic dysfunction-associated steatohepatitis","volume":"5","author":"Sabatini","year":"2024","journal-title":"Cell Rep. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1111\/jgh.12981","article-title":"Influence of gastrointestinal factors on glucose metabolism in patients with cirrhosis","volume":"30","author":"Junker","year":"2015","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_29","first-page":"3522","article-title":"Clinical study of abnormal glucose metabolism and insulin resistance in patients with liver cirrhosis","volume":"13","author":"Li","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Yen, F.S., Hou, M.C., Liu, J.S., Hsu, C.C., and Hwu, C.M. (2022). Severe hypoglycemia in patients with liver cirrhosis and type 2 diabetes. Front. Med., 9.","DOI":"10.3389\/fmed.2022.962337"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"316-e7","DOI":"10.1016\/j.jcrc.2013.11.002","article-title":"Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis","volume":"29","author":"Pfortmueller","year":"2014","journal-title":"J. Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1210\/jcem.87.7.8638","article-title":"Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men","volume":"87","author":"Vehkavaara","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.2337\/db15-1552","article-title":"Insulin Regulates Hepatic Triglyceride Secretion and Lipid Content via Signaling in the Brain","volume":"65","author":"Scherer","year":"2016","journal-title":"Diabetes"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00125-005-0070-x","article-title":"Non-esterified fatty acid concentrations are independently associated with hepatic steatosis in obese subjects","volume":"49","author":"Holt","year":"2006","journal-title":"Diabetologia"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s00535-009-0133-8","article-title":"Steatosis and hepatic expression of genes regulating lipid metabolism in Japanese patients infected with hepatitis C virus","volume":"45","author":"Yasui","year":"2010","journal-title":"J. Gastroenterol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1111\/j.1440-1746.2011.06801.x","article-title":"Hepatic steatosis in hepatitis B virus infected patients: Meta-analysis of risk factors and comparison with hepatitis C infected patients","volume":"26","author":"Machado","year":"2011","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_37","first-page":"347","article-title":"Fatty infiltration of the liver and the development of cirrhosis in diabetes and chronic alcoholism","volume":"14","author":"Connor","year":"1938","journal-title":"Am. J. Pathol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.humpath.2017.09.008","article-title":"Primary sclerosing cholangitis is protective against nonalcoholic fatty liver disease in inflammatory bowel disease","volume":"69","author":"Bosch","year":"2017","journal-title":"Hum. Pathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100479","DOI":"10.1016\/j.jhepr.2022.100479","article-title":"Lipid alterations in chronic liver disease and liver cancer","volume":"4","author":"Paul","year":"2022","journal-title":"JHEP Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101185","DOI":"10.1016\/j.jhepr.2024.101185","article-title":"Lipid metabolism in MASLD and MASH: From mechanism to the clinic","volume":"6","author":"Carli","year":"2024","journal-title":"JHEP Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4425","DOI":"10.1210\/jc.2015-2649","article-title":"Sex-Specific Differences in Hepatic Fat Oxidation and Synthesis May Explain the Higher Propensity for NAFLD in Men","volume":"100","author":"Pramfalk","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/S0168-8278(05)80150-3","article-title":"Lipid metabolism and insulin resistance in cirrhosis","volume":"20","author":"Kaye","year":"1994","journal-title":"J. Hepatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.jhep.2019.11.009","article-title":"Blood metabolomics uncovers inflammation-associated mitochondrial dysfunction as a potential mechanism underlying ACLF","volume":"72","author":"Moreau","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1038\/nature08147","article-title":"Emerging roles for lipids in shaping membrane-protein function","volume":"459","author":"Phillips","year":"2009","journal-title":"Nature"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1016\/j.jhep.2021.01.002","article-title":"Pathophysiology of decompensated cirrhosis: Portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction","volume":"75","author":"Engelmann","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.cell.2015.05.051","article-title":"A Conserved Circular Network of Coregulated Lipids Modulates Innate Immune Responses","volume":"162","author":"Koberlin","year":"2015","journal-title":"Cell"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Grammatikos, G., Ferreiros, N., Waidmann, O., Bon, D., Schroeter, S., Koch, A., Herrmann, E., Zeuzem, S., Kronenberger, B., and Pfeilschifter, J. (2015). Serum Sphingolipid Variations Associate with Hepatic Decompensation and Survival in Patients with Cirrhosis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138130"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Becker, S., Kinny-Koster, B., Bartels, M., Scholz, M., Seehofer, D., Berg, T., Engelmann, C., Thiery, J., Ceglarek, U., and Kaiser, T. (2017). Low sphingosine-1-phosphate plasma levels are predictive for increased mortality in patients with liver cirrhosis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174424"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e00013","DOI":"10.14309\/ctg.0000000000000013","article-title":"Reduced Serum Sphingolipids Constitute a Molecular Signature of Malnutrition in Hospitalized Patients with Decompensated Cirrhosis","volume":"10","author":"Rachakonda","year":"2019","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.jhep.2020.03.046","article-title":"Targeted lipidomics reveals extensive changes in circulating lipid mediators in patients with acutely decompensated cirrhosis","volume":"73","author":"Checa","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Schwarzkopf, K.M., Queck, A., Thomas, D., Angioni, C., Cai, C., Freygang, Y., Ruschenbaum, S., Geisslinger, G., Zeuzem, S., and Welsch, C. (2019). Omega-3 and -6 fatty acid plasma levels are not associated with liver cirrhosis-associated systemic inflammation. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211537"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1038\/nm.3516","article-title":"Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2","volume":"20","author":"Fullerton","year":"2014","journal-title":"Nat. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"5713","DOI":"10.1016\/S0021-9258(18)63618-X","article-title":"Control of gluconeogenesis from amino acids in the perfused rat liver","volume":"244","author":"Mallet","year":"1969","journal-title":"J. Biol. Chem."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1016\/j.cmet.2024.10.001","article-title":"Amino acid is a major carbon source for hepatic lipogenesis","volume":"36","author":"Liao","year":"2024","journal-title":"Cell Metab."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1002\/hep.1840160326","article-title":"Zinc supplementation reduces blood ammonia and increases liver ornithine transcarbamylase activity in experimental cirrhosis","volume":"16","author":"Riggio","year":"1992","journal-title":"Hepatology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1016\/j.nut.2014.04.018","article-title":"Effect of zinc on liver cirrhosis with hyperammonemia: A preliminary randomized, placebo-controlled double-blind trial","volume":"30","author":"Katayama","year":"2014","journal-title":"Nutrition"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.nut.2014.03.016","article-title":"Ammonia and amino acid profiles in liver cirrhosis: Effects of variables leading to hepatic encephalopathy","volume":"31","author":"Holecek","year":"2015","journal-title":"Nutrition"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1002\/hep.30692","article-title":"Muscle Alterations Are Associated with Minimal and Overt Hepatic Encephalopathy in Patients with Liver Cirrhosis","volume":"70","author":"Nardelli","year":"2019","journal-title":"Hepatology"},{"key":"ref_59","first-page":"CD001939","article-title":"Branched-chain amino acids for people with hepatic encephalopathy","volume":"5","author":"Gluud","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_60","first-page":"513","article-title":"The BCAA\/AAA ratio of plasma amino acids in three different groups of cirrhotics","volume":"44","author":"Campollo","year":"1992","journal-title":"Rev. Investig. Clin."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1016\/j.jhep.2016.07.040","article-title":"Sarcopenia from mechanism to diagnosis and treatment in liver disease","volume":"65","author":"Dasarathy","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1002\/hep.29107","article-title":"Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis","volume":"65","author":"Kumar","year":"2017","journal-title":"Hepatology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"293","DOI":"10.33549\/physiolres.934648","article-title":"The role of skeletal muscle in the pathogenesis of altered concentrations of branched-chain amino acids (valine, leucine, and isoleucine) in liver cirrhosis, diabetes, and other diseases","volume":"70","author":"Holecek","year":"2021","journal-title":"Physiol. Res."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Espina, S., Gonzalez-Irazabal, Y., Sanz-Paris, A., Lopez-Yus, M., Garcia-Sobreviela, M.P., Del Moral-Bergos, R., Garcia-Rodriguez, B., Fuentes-Olmo, J., Bernal-Monterde, V., and Arbones-Mainar, J.M. (2021). Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy. Nutrients, 13.","DOI":"10.3390\/nu13113764"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"47","DOI":"10.21037\/tgh.2018.07.06","article-title":"Branched-chain amino acids in liver diseases","volume":"3","author":"Tajiri","year":"2018","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/nature13568","article-title":"Alterations of the human gut microbiome in liver cirrhosis","volume":"513","author":"Qin","year":"2014","journal-title":"Nature"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1038\/ajg.2013.221","article-title":"Large-scale survey of gut microbiota associated with MHE Via 16S rRNA-based pyrosequencing","volume":"108","author":"Zhang","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"3780","DOI":"10.3748\/wjg.v28.i29.3780","article-title":"Structural changes of proteins in liver cirrhosis and consequential changes in their function","volume":"28","author":"Gligorijevic","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"E304","DOI":"10.1152\/ajpendo.00333.2001","article-title":"Impairment of albumin and whole body postprandial protein synthesis in compensated liver cirrhosis","volume":"282","author":"Tessari","year":"2002","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"E983","DOI":"10.1152\/ajpendo.00183.2012","article-title":"Hyperammonemia-mediated autophagy in skeletal muscle contributes to sarcopenia of cirrhosis","volume":"303","author":"Qiu","year":"2012","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1002\/hep.27717","article-title":"Metabolic and molecular responses to leucine-enriched branched chain amino acid supplementation in the skeletal muscle of alcoholic cirrhosis","volume":"61","author":"Tsien","year":"2015","journal-title":"Hepatology"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.jhep.2021.11.006","article-title":"Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis","volume":"76","author":"Tantai","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1002\/lt.24750","article-title":"A multicenter study to define sarcopenia in patients with end-stage liver disease","volume":"23","author":"Carey","year":"2017","journal-title":"Liver Transpl."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1038\/ctg.2015.31","article-title":"Inclusion of Sarcopenia Within MELD (MELD-Sarcopenia) and the Prediction of Mortality in Patients with Cirrhosis","volume":"6","author":"Baracos","year":"2015","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1002\/hep.22367","article-title":"Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: A randomized 12-month trial","volume":"48","author":"Plank","year":"2008","journal-title":"Hepatology"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Ismaiel, A., Bucsa, C., Farcas, A., Leucuta, D.C., Popa, S.L., and Dumitrascu, D.L. (2022). Effects of Branched-Chain Amino Acids on Parameters Evaluating Sarcopenia in Liver Cirrhosis: Systematic Review and Meta-Analysis. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.749969"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"3350","DOI":"10.1007\/s10620-019-06034-2","article-title":"Home-Based Physical Activity and Diet Intervention to Improve Physical Function in Advanced Liver Disease: A Randomized Pilot Trial","volume":"65","author":"Chen","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s00535-023-02060-0","article-title":"Resistance exercise in combination with aerobic exercise reduces the incidence of serious events in patients with liver cirrhosis: A meta-analysis of randomized controlled trials","volume":"59","author":"Kawaguchi","year":"2024","journal-title":"J. Gastroenterol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.jhep.2016.06.007","article-title":"Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone: A randomised controlled trial","volume":"65","author":"Sinclair","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/HEP.0000000000000820","article-title":"Continuous home terlipressin infusion increases handgrip strength and reduces ascites-A prospective randomized crossover study","volume":"80","author":"Terbah","year":"2024","journal-title":"Hepatology"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Singh Tejavath, A., Mathur, A., Nathiya, D., Singh, P., Raj, P., Suman, S., Mundada, P.R., Atif, S., Rai, R.R., and Tomar, B.S. (2021). Impact of Branched Chain Amino Acid on Muscle Mass, Muscle Strength, Physical Performance, Combined Survival, and Maintenance of Liver Function Changes in Laboratory and Prognostic Markers on Sarcopenic Patients with Liver Cirrhosis (BCAAS Study): A Randomized Clinical Trial. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.715795"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.14309\/ajg.0000000000001301","article-title":"Adding Branched-Chain Amino Acids to an Enhanced Standard-of-Care Treatment Improves Muscle Mass of Cirrhotic Patients with Sarcopenia: A Placebo-Controlled Trial","volume":"116","author":"Llop","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"10984","DOI":"10.12998\/wjcc.v10.i30.10984","article-title":"Branched-chain amino acids supplementation has beneficial effects on the progression of liver cirrhosis: A meta-analysis","volume":"10","author":"Du","year":"2022","journal-title":"World J. Clin. Cases"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/j.clnu.2022.03.027","article-title":"Efficacy of branched chain amino acids supplementation in liver cirrhosis: A systematic review and meta-analysis","volume":"41","author":"Konstantis","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40560-024-00771-x","article-title":"Intravenous branched-chain amino acid administration for the acute treatment of hepatic encephalopathy: A systematic review and meta-analysis","volume":"13","author":"Yokobori","year":"2025","journal-title":"J. Intensive Care"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/apt.17917","article-title":"Branched-chain amino acid supplementation does not improve measures of sarcopenia in cirrhosis: Results of a randomised controlled trial","volume":"59","author":"Hey","year":"2024","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Yu, L., Paski, S.C., Dodge, J., Bambha, K., Biggins, S.W., and Ioannou, G.N. (2023). Effect of dietary branched chain amino acids on liver related mortality: Results from a large cohort of North American patients with advanced HCV infection. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0284739"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e13909","DOI":"10.1111\/eci.13909","article-title":"Systematic review with meta-analysis: Branched-chain amino acid supplementation in liver disease","volume":"53","author":"Portincasa","year":"2023","journal-title":"Eur. J. Clin. Investig."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/21\/3346\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T05:24:22Z","timestamp":1761629062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/21\/3346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":88,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["nu17213346"],"URL":"https:\/\/doi.org\/10.3390\/nu17213346","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,24]]}}}