Fig. 1.

Summary of factors and pathways contributing to sarcopenia in cirrhosis. Numerous factors such as portal hypertension complications, pro-inflammatory cytokines, hyperammonemia, loop diuretics, hypotestosteronemia, physical inactivity, elevated hepatic gluconeogenesis, impaired insulin/IGF-1 signaling and alcoholic cirrhosis associate with sarcopenia in cirrhosis. Several signaling pathways including ubiquitin–proteasome degradation, myostatin activation, impaired mitochondrial function, NFκB signaling, mTOR inhibition, apoptosis and elevated eIF2 phosphorylation are involved in sarcopenia in cirrhosis. BCAA branched-chain amino acids, eIF2 eukaryotic initiation factor 2, IGF-1 insulin-like growth factor 1, NFκB nuclear factor κB