Figure 2.

Factors and pathways are influencing sarcopenia in advanced chronic liver disease. Physical inactivity, elevated hepatic gluconeogenesis, impaired insulin/IGF-1 signalling, alcoholic cirrhosis, portal hypertension complications, pro-inflammatory cytokines, hyperammonemia, loop diuretics and hypotestosteronemia are all factors associated with sarcopenia in advanced chronic liver disease. Several signalling pathways, in particular, myostatin activation and ubiquitin–proteasome degradation, influence and alter mitochondrial function; mTOR inhibition, NFkB signalling, apoptosis and elevated eIF2 phosphorylation are involved in sarcopenia in advanced chronic liver disease. BCAA branched-chain amino acids, eIF2 eukaryotic initiation factor 2, IGF-1 insulin-like growth factor 1, NFkB nuclear factor-kB. Modified by [72].