Саркопения у пациентов с неалкогольной жировой болезнью печени: патогенез, диагностика и лечение (мнение экспертов)

Введение. В настоящее время врачи различных специальностей все чаще стали диагностировать саркопению - заболевание, характеризующееся снижением массы, силы и функции мышц. Саркопения чаще диагностируется у лиц пожилого и старческого возрастов, но может выявляться и у лиц среднего и молодого возрастов как следствие различных заболеваний. Ряд исследований демонстрируют связь саркопении с неалкогольной жировой болезнью печени (НАЖБП). На сегодняшний день остаются нерешенными вопросы диагностики и лечения саркопении в рутинной клинической практике у больных с НАЖБП, а также влияние терапии саркопении на профилактику осложнений и прогрессирование НАЖБП. Методология. Научное общество гастроэнтерологов России (НОГР) объединило 12 экспертов в области изучения саркопении и НАЖБП для вынесения аргументированных положений и рекомендаций по проблеме «Саркопения у пациентов с неалкогольной жировой болезнью печени: патогенез, диагностика и лечение». Расширенный литературный поиск статей на английском языке проводился по ключевым словам - саркопения, классификация саркопении, фенотипы и патогенез саркопении, современные методы диагностики и потенциальные немедикаментозные (рациональное питание и физическая активность) и терапевтические методы коррекции саркопении, неалкогольная жировая болезнь печени в следующих международных базах данных: PubMed, Google Scholar, Web of Science, Embase, Cochrane Database, поиск проводимых актуальных исследований - на сайте ClinicalTrials.gov. Расширенный литературный поиск осуществлялся на русском языке в базах данных: электронный ресурс «Рубрикатор клинических рекомендаций МЗ РФ», eLibrary, RusMed. Согласно полученной информации, текст структурирован в отдельные главы. Каждая глава содержит ключевые положения (мнение экспертов) по соответствующему разделу и собственно имеющиеся на сегодняшний день данные, касающиеся того или иного раздела. Авторами представлены таблицы, выводы экспертов и список современной литературы, посвященной саркопении и ее фенотипам. Результаты (по ключевым положениям). Эксперты работали над определением наиболее значимых проблем по указанной теме, сформулировали актуальные для клинической практики вопросы и дали на них аргументированные ответы, оформленные как «положения» для клинической практики с комментариями на основе доказательной медицины. В основу формулировки вопросов, рекомендаций и положений лег критический анализ медицинской литературы в англоязычных и русскоязычных базах данных. Результаты работы экспертов имеют прямое отношение к качественному ведению пациентов с саркопенией и НАЖБП, сформулированные ими ключевые положения могут использоваться в клинической практике. Выводы. Представляемый группой экспертов документ «Саркопения у пациентов с неалкогольной жировой болезнью печени: патогенез, диагностика и лечение» призван помочь практическим врачам улучшить знания по проблеме саркопении и научиться рано диагностировать синдром в рутинной клинической практике, причем не только у пациентов старших возрастных групп, но и у больных молодого и среднего возраста, у кого саркопения развивается как следствие хронических заболеваний.

1. Rosenberg I.H. Epidemiologic and methodologic problems in determining nutritional status of older persons. Am J Clin Nutr. 1989; 50(5): 1121-1235.

2. Cruz-Jentoft A.J., Baeyens J.P., Bauer J.M. et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39(4): 412-423. doi: 10.1093/ageing/afq034.

3. Akhmedov V.A., Marinenko V.S. Sarcopenia and non-alcoholic fatty liver disease - complex pathogenetic relationships. Experimental and Clinical Gastroenterology. 2024; (9): 110-118. (In Russ.) doi: 10.31146/1682-8658-ecg-229-9-110-118.@@ Ахмедов В.А., Мариненко В.С. Саркопения и неалкогольная жировая болезнь печени - сложные патогенетические взаимосвязи. Экспериментальная и клиническая гастроэнтерология. 2024; (9): 110-118. doi: 10.31146/1682-8658-ecg-229-9-110-118

4. Khoroshilov I.E. Sarcopenia in patients: diagnosis possibilities and therapy perspective. Medical J. 2017; 8: 36-40. (In Russ.)@@ Хорошилов И.Е. Саркопения у больных: возможности диагностики и перспективы лечения. Лечащий врач. 2017; 8: 36-40.

5. Ticinesi A., Nouvenne A., Cerundolo N. et al. Gut Microbiota, Muscle Mass and Function in Aging: A Focus on Physical Frailty and Sarcopenia. Nutrients. 2019; 11(7): 1633. doi: 10.3390/nu11071633.

6. Rinella M.E., Neuschwander-Tetri B.A., Siddiqui M.S. et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023; 77(5): 1797-1835. doi: 10.1097/HEP.0000000000000323.

7. Cruz-Jentoft A.J., Bahat G., Bauer J.M. et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019; 48(1): 16-31. doi: 10.1093/ageing/afy169.

8. Petermann-Rocha F., Balntzi V., Gray S.R. et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcop Muscle. 2022; 13: 86-99. doi: 10.1002/jcsm.12783.

9. Younossi Z.M., Golabi P., Paik J.M. et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023; 77(4): 1335-1347. doi: 10.1097/HEP.0000000000000004.

10. Ivashkin V.T., Drapkina O.M., Maev I.V. et al. Prevalence of non-alcoholic fatty liver disease in outpatient practice patients in the Russian Federation: results of the DIREG 2 study.Russian Journal of Gastroenterology, Hepatology, and Coloproctology. 2015; 25(6): 31-41.@@ Ивашкин В.Т., Драпкина О.М., Маев И.В. и др. Распространенность неалкогольной жировой болезни печени у пациентов амбулаторно-поликлинической практики в Российской Федерации: результаты исследования DIREG 2. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2015; 25(6): 31-41.

11. Estes C., Razavi H., Loomba R. et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018; 67: 123-133. doi: 10.1002/hep.29466.

12. Myazin R.G. Sarcopenia and non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2024; 222 (2): 120-130. (In Russ.) doi: 10.31146/1682-8658-ecg-222-2-120-130.@@ Мязин Р.Г. Саркопения и неалкогольная жировая болезнь печени. Экспериментальная и клиническая гастроэнтерология. 2024; 222 (2): 120-130. doi: 10.31146/1682-8658-ecg-222-2-120-130.

13. Koo B.K., Kim D., Joo S.K. et al. Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis. J Hepatol. 2017; 66: 123-131. doi: 10.1016/j.jhep.2016.08.019.

14. Giri S., Anirvan P., Angadi S. et al. Prevalence and outcome of sarcopenia in non-alcoholic fatty liver disease. World J Gastrointest Pathophysiol. 2024; 15(1): 91100. doi: 10.4291/wjgp.v15.i1.91100.

15. Sinn D.H., Kang D., Kang M. et al. Nonalcoholic fatty liver disease and accelerated loss of skeletal muscle mass: a longitudinal cohort study. Hepatology. 2022; 76: 1746-1754. doi: 10.1002/hep.32578.

16. Roh E., Hwang S.Y., Yoo H.J. et al. Impact of non-alcoholic fatty liver disease on the risk of sarcopenia: a nationwide multicenter prospective study. Hepatol Int. 2022; 16(3): 545-554. doi: 10.1007/s12072-021-10258-8.

17. Montano-Loza A.J., Angulo P., Meza-Junco J. et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle. 2016; 7: 126-135. doi: 10.1002/jcsm.12039.

18. Tantai X., Liu Y., Yeo Y.H. et al. Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2022; 76: 588-599. doi: 10.1016/j.jhep.2021.11.006.

19. Schiavo L., Busetto L., Cesaretti M. et al. Nutritional issues in patients with obesity and cirrhosis. World J Gastroenterol. 2018; 24: 3330-3346. doi: 10.3748/wjg.v24.i30.3330.

20. Tandon P., Montano-Loza A.J., Lai J.C. et al. Sarcopenia and frailty in decompensated cirrhosis. J Hepatol. 2021; 75: 147-162. doi: 10.1016/j.jhep.2021.01.025.

21. Buckinx F., Landi F., Cesari M. et al. Pitfalls in the measurement of muscle mass: a need for a reference standard. J Cachexia Sarcopenia Muscle. 2018; 9: 269-78. doi: 10.1002/jcsm.12268.

22. Masanes F., Rojano ILX., Salva A. et al. Cut-off points for muscle mass-not grip strength or gait speed-determine variations in sarcopenia prevalence. J Nutr Health Aging. 2017; 21: 825-29. doi: 10.1007/s12603-016-0844-5.

23. De Sire R., Rizzatti G., Ingravalle F. et al. Skeletal muscle-gut axis: emerging mechanisms of sarcopenia for intestinal and extra intestinal diseases. Minerva Gastroenterol Dietol. 2018; 64(4): 351-362. doi:10.23736/s1121-421x.18.02511-4.

24. Sanchez Tocino M.L., Cigarran S., Urena P. et al. Definition and evolution of the concept of sarcopenia. Nefrologia. 2024; 44(3): 323-330. doi: 10.1016/j.nefro.2023.08.001.

25. Morley J.E., Abbatecola A.M., Argiles J.M. et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc. 2011; 12: 403-409.

26. Clark B.C. Manini T.M. Functional consequences of sarcopenia and dynapenia in the elderly. Curr Opin Clin Nutr Metab Care. 2010; 13: 271-276. doi: 10.1097/MCO.0b013e328337819e.

27. Suetta C., Haddock B., Alcazar J. et al. The Copenhagen Sarcopenia Study: lean mass, strength, power, and physical function in a Danish cohort aged 20-93 years. Journal of Cachexia, Sarcopenia and Muscle. 2019; 1316-29. doi: 10.1002/jcsm.12477.

28. Radaelli R., Trajano G.S., Freitas S.R. et al. Power training prescription in older individuals: is it safe and effective to promote neuromuscular functional improvements? Sports Med. 2023; 53: 569-576. doi: 10.1007/s40279-022-01758-0.

29. Wilkinson D.J., Piasecki M., Atherton P.J. The age-related loss of skeletal muscle mass and function: measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018; 47: 123-132. doi: 10.1016/j.arr.2018.07.005.

30. Na-Hyung Kim, Choon Young Kim. Association of Micronutrients and Handgrip Strength in Korean Older Population: A Cross-Sectional Study. Healthcare (Basel). 2022; 10(10): 1980. doi: 10.3390/healthcare10101980.

31. Ivashkin V.T., Maevskaya M.V., Zharkova M.S. et al. Clinical Practice Guidelines of the Russian Scientific Liver Society, Russian Gastroenterological Association, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians and National Society for Preventive Cardiology on Diagnosis and Treatment of Non-Alcoholic Liver Disease.Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(4):104-140. doi: 10.22416/1382-4376-2022-32-4-104-140.@@ Ивашкин В.Т., Маевская М.В., Жаркова М.С. и др. Клинические рекомендации Российского общества по изучению печени, Российской гастроэнтерологической ассоциации, Российской ассоциации эндокринологов, Российской ассоциации геронтологов и гериатров и Национального общества профилактической кардиологии по диагностике и лечению неалкогольной жировой болезни печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2022;32(4):104-140. doi: 10.22416/1382-4376-2022-32-4-104-140.

32. Cai C., Song, X., Chen Y. et al. Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a systematic review and meta-analysis. Hepatol Int. 2020; 14: 115-126. doi: 10.1007/s12072-019-09964-1.

33. Golabi P., Gerber L., Paik J.M. et al. Contribution of sarcopenia and physical inactivity to mortality in people with non-alcoholic fatty liver disease. J HEP Rep. 2020; 2(6): 100171. doi: 10.1016/j.jhepr.2020.100171.

34. Iwaki M., Kobayashi T., Nogami A. et al. Impact of Sarcopenia on Non-Alcoholic Fatty Liver Disease. Nutrients. 2023; 15(4): 891. doi: 10.3390/nu15040891.

35. Kim H.K., Bae S.J., Lee M.J. еt al. Association of Visceral Fat Obesity, Sarcopenia, and Myosteatosis with Non-Alcoholic Fatty Liver Disease without Obesity. J Clin Mol Hepatol. 2023; 29(4): 987-1001. doi: 10.3350/cmh.2023.0035.

36. Chung G.E., Oh S., Ahn D.W. еt al. Effects of additive interactions among obesity, visceral adiposity, and sarcopenia on nonalcoholic fatty liver disease. Sci Rep. 2023; 13(1): 3628. doi: 10.1038/s41598-023-30833-3.

37. Chung H.H. Enhanced muscle function in cause-specific mortality among patients with NAFLD-related sarcopenia. Liver Int. 2023; 43(8): 1837-1838. doi: 10.1111/liv.15617.

38. Cahill G.F., Herrera M.G., Morgan A.P. еt al. Hormone-fuel interrelationships during fasting. J Clin Invest. 1966; 45: 1751-69. doi: 10.1172/JCI105481.

39. Goodpaster B.H., Sparks L.M. Metabolic flexibility in health and disease. Cell Metab. 2017; 25: 1027-36. doi: 10.1016/j.cmet.2017.04.015.

40. Polyzos S.A., Vachliotis I.D., Mantzoros C.S. Sarcopenia, sarcopenic obesity and nonalcoholic fatty liver disease. Metabolism. 2023; 147: 155676. doi: 10.1016/j.metabol.2023.155676.

41. Bali T., Chrysavgis L., Cholongitas E. Metabolic-Associated Fatty Liver Disease and Sarcopenia. Endocrinol Metab Clin North Am. 2023; 52(3): 497-508. doi: 10.1016/j.ecl.2023.02.004.

42. Nachit M., Lanthier N., Rodriguez J. et al. A dynamic association between myosteatosis and liver stiffness: Results from a prospective interventional study in obese patients. JHEP Rep. 2021; 3(4): 100323. doi: 10.1016/j.jhepr.2021.100323.

43. Sung M.J., Lim T.S., Jeon M.Y. еt al. Sarcopenia Is Independently Associated with the Degree of Liver Fibrosis in Patients with Type 2 Diabetes Mellitus. Gut Liver. 2020; 14(5): 626-635. doi: 10.5009/gnl19126.

44. El Sherif O., Dhaliwal A., Newsome P.N. et al. Sarcopenia in nonalcoholic fatty liver disease: new challenges for clinical practice. Expert Rev Gastroenterol Hepatol. 2020; 14(3): 197-205. doi: 10.1080/17474124.2020.1731303

45. Aditya Viswanath, Sherouk Fouda, Cornelius James Fernandez, Joseph M. Pappachan. Metabolic-associated fatty liver disease and sarcopenia: A double whammy. World J Hepatol. 2024; 16(2): 152-163. doi: 10.4254/wjh.v16.i2.152.

46. Lee J.H., Lee H.S., Lee B.K. еt al. Relationship between Muscle Mass and Non-Alcoholic Fatty Liver Disease. Biology (Basel). 2021; 10(2): 122. doi: 10.3390/biology10020122.

47. Wu H.T., Ou H-Y., Hung H-C. et al. Novel hepatokine, HFREP1, plays a crucial role in the development of insulin resistance and type 2 diabetes. Diabetologia. 2016; 59: 1732-1742. doi: 10.1007/s00125-016-3991-7.

48. Jung T.W., Chung Y.H., Kim H-C. et al. Hyperlipidemia-induced hepassocin in the liver contributes to insulin resistance in skeletal muscle. Mol Cell Endocrinol. 2018; 470: 26-33. doi: 10.1016/j.mce.2017.10.014.

49. Dijk W., Beigneux AP., Larsson M. et al. Angiopoietin-like 4 promotes intracellular degradation of lipoprotein lipase in adipocytes. J Lipid Res. 2016; 57:1670-1683. doi: 10.1194/jlr.M067363.

50. Mukhopadhyay S., Bhattacharya S. Plasma fetuin-A triggers inflammatory changes in macrophages and adipocytes by acting as an adaptor protein between NEFA and TLR-4. Diabetologia. 2016; 59: 859-860. doi: 10.1007/s00125-016-3866-y.

51. Yang Q., Graham TE., Mody N. et al. Serum retinol binding protein 4 contributes to insulin resistance in obesity and type 2 diabetes. Nature. 2005; 436: 356-362. doi: 10.1038/nature03711.

52. Han E., Kim M.K., Im S.S. еt al. Non-alcoholic fatty liver disease and sarcopenia is associated with the risk of albuminuria independent of insulin resistance, and obesity. J Diabetes Complications. 2022; 36(8): 108253. doi: 10.1016/j.jdiacomp.2022.108253.

53. Camporez J.P.G., Jornayvaz F.R., Petersen M.C. et al. Cellular mechanisms by which FGF21 improves insulin sensitivity in male mice. Endocrinology. 2013; 154: 3099-3109. doi: 10.1210/en.2013-1191.

54. Meex R.C.R., Watt M.J. Hepatokines: linking nonalcoholic fatty liver disease and insulin resistance. Nat Rev Endocrinol. 2017; 13: 509-520. doi: 10.1038/nrendo.2017.56.

55. Kim S.H., Jeong J.B., Kang J. et al. Association between sarcopenia level and metabolic syndrome. PLoS One. 2021; 16(3): e0248856. doi: 10.1371/journal.pone.0248856.

56. Cho Y., Park H.S., Huh B.W. еt al. Non-Alcoholic Fatty Liver Disease with Sarcopenia and Carotid Plaque Progression Risk in Patients with Type 2 Diabetes Mellitus. Diabetes Metab J. 2023; 47(2): 232-241. doi: 10.4093/dmj.2021.0355.

57. Shirakami Y., Kato J., Maeda T. et al. Skeletal muscle atrophy is exacerbated by steatotic and fibrotic liver-derived TNF-α in senescence-accelerated mice. J Gastroenterol Hepatol. 2023; 38(5): 800-808. doi: 10.1111/jgh.16171.

58. Kob R., Bollheimer L.C., Bertsch T. et al. Sarcopenic obesity: molecular clues to a better understanding of its pathogenesis? Biogerontology. 2015;16:15-29. doi: 10.1007/s10522-014-9539-7.

59. Kim T.H., Jeong C.W., Lee C. et al. Association between Body Composition Contents and Hepatic Fibrosis in Sarcopenic Obesity. J Clin Med. 2023; 12(13): 4279. doi: 10.3390/jcm12134279.

60. Obstfeld A.E., Sugaru E., Thearle M. et al. Chemokine receptor 2 (CCR2) regulates the hepatic recruitment of myeloid cells that promote obesity-induced hepatic steatosis. Diabetes. 2010; 59: 916-25. doi: 10.2337/db09-1403.

61. Zhao Q., Yin Y., Deng Y. Metabolic associated fatty liver disease and sarcopenia additively increase mortality: a real-world study. Nutr Diabetes. 2023; 13(1): 21. doi: 10.1038/s41387-023-00250-6.

62. Yan F., Nie G., Zhou N. et al. Association of fat-to-muscle ratio with non-alcoholic fatty liver disease: a single-centre retrospective study. BMJ Open. 2023; 13(10): e072489. doi: 10.1136/bmjopen-2023-072489.

63. Giudice J., Taylor J.M. Muscle as a paracrine and endocrine organ. Curr Opin Pharmacol. 2017; 34: 49-55. doi: 10.1016/j.coph.2017.05.005.

64. Severinsen M.C.K., Pedersen B.K. Muscle-Organ Crosstalk: The Emerging Roles of Myokines. Endocr Rev. 2020; 41(4): 594-609. doi: 10.1210/endrev/bnaa016.

65. Mancinelli R., Checcaglini F., Coscia F. et al. Biological Aspects of Selected Myokines in Skeletal Muscle: Focus on Aging.Int J Mol Sci. 2021; 22(16): 8520. doi: 10.3390/ijms22168520.

66. Dao T., Green A.E., Kim Y.A. et al. Sarcopenia and Muscle Aging: A Brief Overview. Endocrinol Metab (Seoul). 2020; 35(4): 716-732. doi: 10.3803/EnM.2020.405.

67. Huh J.Y., Dincer F., Mesfum E. еt al. Irisin stimulates muscle growthrelated genes and regulates adipocyte differentiation and metabolism in humans.Int J Obes. 2014; 38: 1538-1544. doi: 10.1038/ijo.2014.42.

68. Kukes V.G., Gazdanova A.A., Furalev V.A. et al. Modern understanding of the biological role and clinical significance of myostatin, the main regulator of muscle growth and differentiation. Medical Bulletin of the North Caucasus. 2021; 16(3): 327-332. (in Russ.) doi: 10.14300/mnnc.2021.16079.@@ Кукес В.Г., Газданова А.А., Фуралев В.А. и др. Современное представление о биологической роли и клиническом значении миостатина - главного регулятора роста и дифференцировки мышц. Медицинский вестник Северного Кавказа. 2021; 16(3): 327-332. doi: 10.14300/mnnc.2021.16079.

69. Elkina Y., von Haehling S. Anker SD. еt al. The role of myostatin in muscle wasting: an overview. J Cachexia Sarcopenia Muscle. 2011; 2:143-151. doi: 10.1007/s13539-011-0035-5.

70. Delogu W., Caligiuri A., Provenzano A. et al. Myostatin regulates the fibrogenic phenotype of hepatic stellate cells via cjun N-terminal kinase activation. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2019; 51: 1400-1408. doi: 10.1016/j.dld.2019.03.002.

71. Emhmed Ali, S.; Nguyen, M.H. Sarcopenic Obesity in Non-Alcoholic Fatty Liver Disease - The Union of Two Culprits. Life. 2021; 11: 119. doi: 10.3390/life11020119.

72. Sas E.I., Barnakova V.A. Skeletal muscle hormone activity and non-alcoholic fatty liver disease. Medical alphabet. 2020; (17): 31-34. (In Russ.) doi: 10.33667/2078-5631-2020-17-31-34.@@ Сас Е.И., Барнакова В.А. Гормональная активность скелетной мускулатуры и неалкогольная жировая болезнь печени. Медицинский алфавит. 2020; (17): 31-34. doi: 10.33667/2078-5631-2020-17-31-34.

73. Yang Y.J, Kim D.J. An Overview of the Molecular Mechanisms Contributing to Musculoskeletal Disorders in Chronic Liver Disease: Osteoporosis, Sarcopenia, and Osteoporotic Sarcopenia.International Journal of Molecular Sciences. 2021; 22(5): 2604. doi: 10.3390/ijms22052604.

74. Guo M., Yao J., Li J. et al. Irisin ameliorates age-associated sarcopenia and metabolic dysfunction. J Cachexia Sarcopenia Muscle. 2023; 14(1): 391-405. doi: 10.1002/jcsm.13141.

75. Seldin M.M., Peterson J.M., Byerly M.S. еt al. Myonectin (CTRP15), a novel myokine that links skeletal muscle to systemic lipid homeostasis. J Biol Chem. 2012; 287: 11968-11980. doi: 10.1074/jbc.M111.336834.

76. Manickam R., Duszka K., Wahli W. PPARs and Microbiota in Skeletal Muscle Health and Wasting.Int J Mol Sci. 2020; 21(21): 8056. doi: 10.3390/ijms21218056.

77. Wang G., Li Y., Liu H., Yu X. Gut microbiota in patients with sarcopenia: a systematic review and meta-analysis. Front. Microbiol. 2025; 16:1513253. doi: 10.3389/fmicb.2025.1513253.

78. Neto N.J., Brito M.D., Gomes C.S. et al. Gut microbiota dysbiosis, sarcopenia, osteoporosis and osteosarcopenia in older people: A systematic review protocol. PLOS One. 2025; January 2. doi: 10.1371/journal.pone.0313193.

79. Nikolaychuk A.V., Sokolova A.V., Dragunov D.O. et al. Change in the intestinal microbiota and the risk of progression of sarcopenia. Medicine. 2020; 1: 18-22. (In Russ). doi: 10.24411/2071-5315-2020-12188.@@ Николайчук А.В., Соколова А.В., Драгунов Д.О. и др. Изменение микробиоты кишечника и риск прогрессирования саркопении. Лечебное дело. 2020; 1:18-22. doi: 10.24411/2071-5315-2020-12188.

80. Zhou J., Liu J., Lin Q. et al. Characteristics of the gut microbiome and metabolic profile in elderly patients with sarcopenia. Front Pharmacol. 2023; 14: 1279448. doi: 10.3389/fphar.2023.1279448.

81. Picca A., Fanelli F., Calvani R. Gut Dysbiosis and Muscle Aging: Searching for Novel Targets against Sarcopenia. Mediators Inflamm. 2018. doi: 10.1155/2018/7026198.

82. Zhou J., Liang R., Song Q. et al. Investigating association between gut microbiota and sarcopenia-related traits: a Mendelian randomization study. Precision Clinical Medicine. 2023; 6(2): pbad010. doi: 10.1093/pcmedi/pbad010.

83. Xu Y., Mao T., Wang Y. et al. Effect of Gut Microbiota-Mediated Tryptophan Metabolism on Inflammaging in Frailty and Sarcopenia. J Gerontol A Biol Sci Med Sci. 2024; 79(4): glae044. doi: 10.1093/gerona/glae044.

84. Statsenko M.E., Myazin R.G., Razvalyaeva O.V., Sergeev V.S. The role of the intestinal microbiota in the pathogenesis of the development of non-alcoholic fatty liver disease associated with sarcopenia. Bulletin of the North-Western State Medical University named after. I.I. Mechnikov. 2025 (in press). (In Russ).@@ Стаценко М.Е., Мязин Р.Г., Разваляева О.В., Сергеев В.С. Роль микробиоты кишечника в патогенезе развития неалкогольной жировой болезни печени, ассоциированной с саркопенией. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2025 (в печати).

85. Bhatia V., Singh R., Acharya S.K. Predictive value of arterial ammonia for complications and outcome in acute liver failure. Gut. 2006; 55(1): 98-104. doi: 10.1136/gut.2004.061754.

86. Lazebnik L.B., Golovanova E.V., Alekseenko S.A. et al.Russian Consensus «Hyperammonemia in Adults» (Version 2021). Experimental and Clinical Gastroenterology. 2021; 3: 97-118. (In Russ.) doi: 10.31146/1682-8658-ecg-187-3-97-118.@@ Лазебник Л.Б., Голованова Е.В., Алексеенко С.А. и др. Российский консенсус «Гипераммониемии у взрослых» (Версия 2021). Экспериментальная и клиническая гастроэнтерология. 2021; 3: 97-118. doi: 10.31146/1682-8658-ecg-187-3-97-118.

87. Prikhodko V.A., Okovityy S.V. Psychoneurological disorders in non-alcoholic fatty liver disease. Therapy. 2022; 8(7): 64-77. (In Russ.) doi: 10.18565/therapy.2022.7.64-77.@@ Приходько В.А., Оковитый С.В. Психоневрологические нарушения при неалкогольной жировой болезни печени. Терапия. 2022; 8(7): 64-77. doi: 10.18565/therapy.2022.7.64-77.

88. Musio A., Perazza F., Leoni L. et al. Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease.Int J Mol Sci. 2023; 24(8): 7517. doi: 10.3390/ijms24087517.

89. Chen M., Cao Y., Ji G. et al. Lean nonalcoholic fatty liver disease and sarcopenia. Front Endocrinol (Lausanne). 2023; 14: 1217249. doi: 0.3389/fendo.2023.1217249.

90. Tajiri K., Shimizu Y. Branched-chain amino acids in liver diseases. Transl Gastroenterol Hepatol. 2018; 3: 47. doi: 10.21037/tgh.2018.07.06.

91. Davuluri G., Allawy A., Thapaliya S. et al. Hyperammonaemia-induced skeletal muscle mitochondrial dysfunction results in cataplerosis and oxidative stress. J Physiol. 2016; 594(24): 7341-7360. doi: 10.1113/JP272796.

92. Lai R., Nguyen M.H. Risk Stratification for Sarcopenic Obesity in Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol. 2023; 21(11): 2984. doi: 10.1016/j.cgh.2023.02.012.

93. Cabrera D., Ruiz A., Cabello-Verrugio C. et al. Diet-induced nonalcoholic fatty liver disease is associated with sarcopenia and decreased serum insulin-like growth factor-1. Dig Dis Sci. 2016; 61: 3190-3198. doi:10.1007/s10620-016-4285.

94. Nachit M., De Rudder M., Thissen J-P. et al. Myosteatosis rather than sarcopenia associates with non-alcoholic steatohepatitis in non-alcoholic fatty liver disease preclinical models. J Cachexia Sarcopenia Muscle. 2021; 12: 144-158. doi: 10.1002/jcsm.12646.

95. Poggiogalle E., Lubrano C., Gnessi L. et al. Fatty liver index associates with relative sarcopenia and GH/IGF-1 status in obese subjects. PLoS ONE. 2016; 11: e0145811. doi: 10.1371/journal.pone.0145811.

96. Kadi F. Cellular and molecular mechanisms responsible for the action of testosterone on human skeletal muscle. A basis for illegal performance enhancement. Br J Pharmacol. 2008; 154: 522-528. doi: 10.1038/bjp.2008.118.

97. Nettleship J.E., Pugh P.J., Channer K.S. еt al. Inverse relationship between serum levels of interleukin-1beta and testosterone in men with stable coronary artery disease. Horm Metab Res Horm Stoffwechselforschung Horm Metab. 2007; 39: 366-371. doi: 10.1055/s-2007-976543.

98. Kalyani R.R, Corriere M., Ferrucci L. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabetes Endocrinol. 2014; 2: 819-829. doi: 10.1016/S2213-8587(14)70034-8.

99. Abdulnour J., Doucet E., Brochu M. et al. The effect of the menopausal transition on body composition and cardiometabolic risk factors: a Montreal-Ottawa New Emerging Team group study. Menopause NYN. 2012; 19: 760-767. doi: 10.1097/gme.0b013e318240f6f3.

100. Liu J., Song Y., Wang Y., Hong H. Vitamin D / vitamin D receptor pathway in non-alcoholic fatty liver disease. Expert Opin Ther Targets. 2023; 27(11): 1145-1157. doi: 10.1080/14728222.2023.2274099.

101. Pang Q., Qu K., Liu C. et al. Sarcopenia and nonalcoholic fatty liver disease: New evidence for low vitamin D status contributing to the link. Hepatol Baltim Md. 2016; 63: 675. doi: 10.1002/hep.28010.

102. Muir S.W., Montero-Odasso M. Effect of vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2011; 59: 2291-2300. doi: 10.1111/j.1532-5415.2011.03733.x.

103. Stockton K.A., Mengersen K., Paratz J.D. еt al. Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2011; 22: 859-871. doi: 10.1007/s00198-010-1407-y.

104. Eliades M., Spyrou E., Agrawal N. Metaanalysis: vitamin D and non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2013; 38: 246-254. doi: 10.1111/apt.12377.

105. Kim D., Dennis B.B., Wijarnpreecha K. et al. Muscle strength in non-alcoholic fatty liver disease and all-cause and cause-specific mortality. Liver Int. 2023; 43(2): 513-516. doi: 10.1111/liv.15498.

106. Chun H.S., Lee M., Lee H.A. et al. Association of physical activity with risk of liver fibrosis, sarcopenia, and cardiovascular disease in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2023; 21(2): 358-369. doi: 10.1016/j.cgh.2021.12.043.

107. Yamamoto S., Honma K., Fujii M. et al. SHRSP5/Dmcr rats fed a high-fat and high-cholesterol diet develop disease-induced sarcopenia as nonalcoholic steatohepatitis progresses. Ann Anat. 2023; 249: 152104. doi: 10.1016/j.aanat.2023.152104.

108. Lecoultre V., Egli L., Carrel G. et al. Effects of fructose and glucose overfeeding on hepatic insulin sensitivity and intrahepatic lipids in healthy humans. Obes Silver Spring Md. 2013; 21: 782-785. doi: 10.1002/oby.20377.

109. Han E., Kim M.K., Im S.S. et al. High Sodium Intake, as Assessed by Urinary Sodium Excretion, Is Associated with Nonalcoholic Fatty Liver Disease or Sarcopenia. Gut Liver. 2023; 17(3): 456-465. doi: 10.5009/gnl220133.

110. Baumgartner R., Koehler K., Gallagher D. et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998; 147: 75563.

111. Roubenoff R. Sarcopenia effects on body composition and function. J Gerontol A BiolSci Med Sci. 2003; 58A: 10121017.

112. Burton L.A., Sumukadas D. Optimal management of sarcopenia. Clin Interv Aging. 2010; 5: 217-228. doi: 10.2147/CIA.S11473.

113. Ilich J.Z., Kelly O.J., Inglis J.E. et al.Interrelationship among muscle, fat, and bone: Connecting the dots on cellular, hormonal, and whole body levels. Ageing Res Rev. 2014; 15: 51-60. doi: 10.1016/j.arr.2014.02.007.

114. Perna S., Spadaccini D., Nichetti M. et al. Osteosarcopenic Visceral Obesity and Osteosarcopenic Subcutaneous Obesity, Two New Phenotypes of Sarcopenia: Prevalence, Metabolic Profile, and Risk Factors. J. Aging Res. 2018; doi: 10.1155/2018/6147426.

115. Donini L.M., Busetto L., Bischoff S. et al. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Obes Facts. 2022; 15(3): 321-335. doi: 10.1159/000521241.

116. Lera L., Angel B., Marquez C. et al. Besides Sarcopenia, Pre-Sarcopenia Also Predicts All-Cause Mortality in Older Chileans. Clin Interv Aging. 2021; 16: 611-619. doi: 10.2147/CIA.S289769.

117. Akhmedov V.A., Isaeva A.S. Modern views on the diagnosis of sarcopenia in patients with diffuse liver diseases. Medical alphabet. 2024; 26: 24-27. (In Russ.) doi: 10.33667/2078-5631-2024-26-24-27.@@ Ахмедов В.А., Исаева А.С. Современные взгляды на диагностику саркопении у пациентов с диффузными заболеваниями печени. Медицинский алфавит. 2024; 26: 24-27. doi:10.33667/2078-5631-2024-26-24-27.

118. Malmstrom T.K. Morley J.E. SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia. JAMDA. 2013; 14: 531-532. doi: 10.1016/j.jamda.2013.05.018.

119. Golounina O.O., Fadeev V.V., Belaya Zh.E. Modern guidelines for the diagnosis of sarcopenia. Clinical Medicine, Russian journal. 2023; 101(4-5): 199-207. (In Russ.) doi: 10.30629/0023-2149-2023-101-4-5-198-207.@@ Голоунина О.О., Фадеев В.В., Белая Ж.Е. Современные рекомендации по диагностике саркопении. Клиническая медицина. 2023; 101(4-5): 199-207. doi: 10.30629/0023-2149-2023-101-4-5-198-207.

120. Issa D., Alkhouri N., Tsien C. et al. Presence of sarcopenia (muscle wasting) in patients with nonalcoholic steatohepatitis. Hepatology (Baltimore, Md.). 2014; 60(1): 428-429. doi: 10.1002/hep.26908.

121. Bredella M.A., Ghomi R.H., Thomas B.J. et al.Comparison of DXA and CT in the assessment of body composition in premenopausal women with obesity and anorexia nervosa. Obesity (Silver Spring). 2010; 18: 2227-2233. doi: 10.1038/oby.2010.5.

122. Grinevich V.B., Sas E.I. The role of sarcopenia in the development of non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2020; 183(11): 70-73. (In Russ.) doi: 10.31146/1682-8658-ecg-183-11-70-73.@@ Гриневич В.Б., Сас Е.И. Роль саркопении в развитии неалкогольной жировой болезни печени. Экспериментальная и клиническая гастроэнтерология. 2020; 183(11): 70-73. doi: 10.31146/1682-8658-ecg-183-11-70-73.

123. Noskov S.N., Zavodchikov A.A., Lavrukhina A.A. et al. Clinical significance of sarcopenia and miopenia. RMJ. 2013; 21:1041. (In Russ.)@@ Носков С.Н., Заводчиков А.А., Лаврухина А.А. и др. Клиническое значение саркопении и миопении. РМЖ. 2013; 21:1041.

124. Erokhina A.S., Golovanova E.D. The relationship between comorbidity and sarcopenia: impact on mortality and survival. Doctor. 2021; 6: 60-64. (In Russ.) doi: 10.29296/25877305-2021-06-11.@@ Ерохина А.С., Голованова Е.Д. Взаимосвязь коморбидности и саркопении: влияние на смертность и выживаемость. Врач. 2021; 6: 60-64. doi: 10.29296/25877305-2021-06-11.

125. Landi F., Cruz-Jentoft A.J., Liperoti R. et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013; 42 (2): 203-209. doi: 10.1093/ageing/afs194.

126. Grigorieva I.I., Raskina T.A., Letaeva M.V. et al. Sarcopenia: pathogenesis and diagnosis. Fundamental and Clinical Medicine. 2019; 4(4): 105-116. (In Russ.) doi: 10.23946/2500-0764-2019-4-4-105-116.@@ Григорьева И.И., Раскина Т.А., Летаева М.В. и др. Саркопения: особенности патогенеза и диагностики. Фундаментальная и клиническая медицина. 2019; 4(4): 105-116. doi: 10.23946/2500-0764-2019-4-4-105-116.

127. Ido A., Nakayama Y., Ishii K. et al. Ultrasound-derived abdominal muscle thickness better detects metabolic syndrome risk in obese patients than skeletal muscle index measured by dual energy X-ray absorptiometry. PLoS One. 2015; 10(12): 0143858. doi: 10.1371/journal.pone.0143858.

128. Nijholt W., Scafoglieri A., Jager-Wittenaar H., Van der Schans C.P. The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle. 2017; 8(5): 702-712. doi: 10.1002/jcsm.12210.

129. Thomsen K.L., Eriksen P.L., Kerbert AJ. еt al. Role of ammonia in NAFLD: An unusual suspect. JHEP Rep. 2023; 5(7): 100780. doi: 10.1016/j.jhepr.2023.100780.

130. Goodpaster B.H., Park S.W., Harris T.B. et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol a Biol Sci Med Sci. 2006; 61(10): 1059-1064. doi: 10.1093/gerona/61.10.1059.

131. Shalimar, Sheikh M.F., Mookerjee R.P. et al. Prognostic Role of Ammonia in Patients with Cirrhosis. Hepatology. 2019; 70(3): 982-994. doi: 10.1002/hep.30534.

132. Nadinskaya M. Yu., Mayevskaya M.V., Bakulin I.G. et al. Diagnostic and prognostic value of hyperammonemia in patients with liver cirrhosis, hepatic encephalopathy and sarcopenia (consensus of experts).Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024; 34(1): 85-100. (In Russ.) doi: 10.22416/1382-4376-2024-34-1-85-10.@@ Надинская М.Ю., Маевская М.В., Бакулин И.Г. и др. Диагностическое и прогностическое значение гипераммониемии у пациентов с циррозом печени, печеночной энцефалопатией и саркопенией (соглашение специалистов). Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2024; 34(1): 85-100. doi: 10.22416/1382-4376-2024-34-1-85-10.

133. Shostak N., Muradyantz A., Kondrashov A. Sarcopenia and overlapping syndromes: their value in clinical practice. The Clinician. 2016; 10 (3): 10-14. (In Russ.) doi: 10.17650/1818-8338-2016-10-3-10-14.@@ Шостак Н.А., Мурадянц А.А., Кондрашов А.А. Саркопения и перекрестные синдромы - значение в клинической практике. Клиницист. 2016; 10 (3): 10-14. doi: 10.17650/1818-8338-2016-10-3-10-14.

134. Adamova I.M., Taraki1 B.M., Ibragimova G.M. et al. Effective Pharmacotherapy. Phenotypic Features of Sarcopenia in Fatty Liver Disease. 2024; 20(18): 86-92. (In Russ.) doi:10.33978/2307-3586-2024-20-18-86-92.@@ Адамова И.Г., Тараки Б.М., Г.М. Ибрагимова Г.М. и др. Фенотипические особенности саркопении при жировой болезни печени. Эффективная фармакотерапия. 2024; 20(18): 86-92. doi:10.33978/2307-3586-2024-20-18-86-92.

135. Huo Y.R., Suriyaarachchi P., Gomez F. et al. Phenotype of osteosarcopenia in older individuals with a history of falling. J Am Med Dir Assoc. 2015; 16(4): 290-295. doi: 10.1016/j.jamda.2014.10.018.

136. Batsis J.A., Villareal D.T. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018; 14 (9): 513-537. doi: 10.1038/s41574-018-0062-9.

137. Koliaki C., Liatis S., Dalamaga M., Kokkinos A. Sarcopenic obesity: epidemiologic evidence, pathophysiology and therapeutic perspectives. Curr Obes Rep. 2019; 8(4): 458-471. doi: 10.1007/s13679-019-00359-9.

138. Poggiogalle E., Lubrano C., Sergi G. et al. Sarcopenic obesity and metabolic syndrome in adult caucasian subjects. J Nutr Health Aging. 2016; 20: 958-963. doi: 10.1007/s12603-015-0638-1.

139. Lu W., Feng W., Lai J. et al. Role of adipokines in sarcopenia. Chin Med J. 2023; 136(15): 1794-1804. doi: 10.1097/CM9.0000000000002255.

140. Priego T., Martín A.I., González-Hedström D. et al. Role of hormones in sarcopenia. Vitam Horm. 2021; 115: 535-570. doi: 10.1016/bs.vh.2020.12.021.

141. Kaji H.Interaction between Muscle and Bone. J Bone Metab. 2014; 21(1): 29-40. doi: 10.11005/jbm.2014.21.1.29.

142. Orsatti F.L., Nahas E.A., Nahas-Neto J. et al. Low appendicular muscle mass is correlated with femoral neck bone mineral density loss in postmenopausal women. BMC Musculoskelet Disord. 2011; 12: 225. doi: 10.1186/1471-2474-12-225.

143. Burton L.A., Sumukadas D. Optimal management of sarcopenia. Clin Interv Aging. 2010; 5: 217-228. doi: 10.2147/CIA.S11473.

144. Lee I., Ha C., Kang H. Association of sarcopenia and physical activity with femur bone mineral density in elderly women. J Exerc Nutrition Biochem. 2016; 20(1): 23-28. doi: 10.20463/ jenb.2016.03.20.1.8.

145. Kaji H. Effects of myokines on bone. Bonekey Rep. 2016; 5: 826. doi: 10.1038/bonekey.2016.48.

146. Bosello O., Vanzo A. Obesity paradox and aging. Eat Weight Disord. 2021; 26: 27-35. doi: 10.1007/s40519-019-00815-4.

147. Choi K.M. Sarcopenia and sarcopenic obesity. Korean J Intern Med. 2016; 31(6): 1054-1060. doi: 10.3904/kjim.2016.193.

148. Atkins J.L., Whincup P.H., Morris R.W. et al. Sarcopenic obesity and risk of cardiovascular disease and mortality: a populationbased cohort study of older men. J Am Geriatr Soc. 2014; 62: 253-260. doi: 10.1111/jgs.12652.

149. Chisato Saeki, Mitsuru Saito, Akihito Tsubota. Association of chronic liver disease with bone diseases and muscle weakness. J Bone Miner Metab. 2024; 42(4): 399-412. doi: 10.1007/s00774-023-01488-x.

150. Tarantino U., Visconti V., Bonanni R. et al. Osteosarcopenia and Long-COVID: a dangerous combination. Ther Adv Musculoskelet Dis. 2022; 14: 1759720X221130485. doi: 10.1177/1759720X221130485.

151. Kim Y. Emerging Treatment Options for Sarcopenia in Chronic Liver Disease. Life. 2021; 11(3): 250. doi: 10.3390/life11030250.

152. Rivera F.B., Adizas A., Cubarrubias D. et al. The Roles of Non-Pharmacologic and Emerging Pharmacologic Management of Non-alcoholic Fatty Liver Disease and Sarcopenia: A Narrative Review. J ASEAN Fed Endocr Soc. 2024; 39(1): 84-94. doi: 10.15605/jafes.039.01.04.

153. Haigh L., Kirk C., El Gendy K. et al. The effectiveness and acceptability of Mediterranean diet and calorie restriction in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis. Clin Nutr. 2022; 41(9): 1913-1931. doi: 10.1016/j.clnu.2022.06.037.

154. Younossi Z.M., Corey K.E. Lim J.K. AGA Clinical Practice Update on Lifestyle Modification Using Diet and Exercise to Achieve Weight Loss in the Management of Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology. 2021; 160(3): 912-918. doi: 10.1053/j.gastro.2020.11.051.

155. Shavkuta G.V., Lazebnik L.B. Optimal choice of diet and food products in NAFLD. Experimental and Clinical Gastroenterology. 2024; 10(230): 98-106. doi: 10.31146/1682-8658-ecg-230-10-98-106.@@ Шавкута Г.В., Лазебник Л.Б. Оптимальный выбор диеты и продуктов питания при НАЖБП. Экспериментальная и клиническая гастроэнтерология. 2024; 10(230): 98-106. doi: 10.31146/1682-8658-ecg-230-10-98-106.

156. Zelber-Sagi S., Salomone F., Mlynarsky L. The Mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease: Evidence and plausible mechanisms. Liver Int. 2017; 37(7): 936-949. doi: 10.1111/liv.13435.

157. Zhang X.L., Wang T.Y., Targher G. et al. Lifestyle Interventions for Non-Obese Patients Both with, and at Risk, of Non-Alcoholic Fatty Liver Disease. Diabetes Metab J. 2022; 46(3): 391-401. doi: 10.4093/dmj.2022.0048.

158. Iwaki M., Kobayashi T., Nogami A. et al. Impact of Sarcopenia on Non-Alcoholic Fatty Liver Disease. Nutrients. 2023; 15(4): 891. doi: 10.3390/nu15040891.

159. EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Obes Facts. 2024; 17(4): 374-444. doi: 10.1159/000539371.

160. Berzigotti A., Albillos A., Villanueva C. et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The Sport Diet study. Hepatology. 2017; 65(4): 1293-305. doi: 10.1002/hep.28992.

161. Lai J.C., Tandon P., Bernal W. et al. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology (Baltimore, Md). 2021; 74(3): 1611-44. doi: 10.1002/hep.32049.

162. Bischoff S.C., Bernal W., Dasarathy S. et al. ESPEN practical guideline: Clinical nutrition in liver disease. Clin Nutr. 2020; 39(12): 3533-3562. doi: 10.1016/j.clnu.2020.09.001.

163. Tandon P., Ney M., Irwin I. et al. Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 2012; 18: 1209-1216. doi: 10.1002/lt.23495.

164. Tandon P., Low G., Mourtzakis M. et al. A Model to Identify Sarcopenia in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2016; 14: 1473-1480 e1473. doi: 10.1016/j.cgh.2016.04.040.

165. European Association for the Study of the Liver. Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. 2019; 70(1): 172-193. doi: 10.1016/j.jhep.2018.06.024.

166. Bischoff S.C., Ockenga J., Eshraghian A. et al. Practical guideline on obesity care in patients with gastrointestinal and liver diseases - Joint ESPEN/UEG guideline. Clin Nutr. 2023; 42(6): 987-1024. doi: 10.1016/j.clnu.2023.03.021.

167. Ivashkin V.T., Maevskaya M.V., Zharkova M.S. et al. Clinical Recommendations of the Russian Scientific Liver Society and Russian Gastroenterological Association on Diagnosis and Treatment of Liver Fibrosis, Cirrhosis and Their Complications.Rus J Gastroenterol Hepatol Coloproctol. 2021; 31(6): 56-102. (In Russ.) doi: 10.22416/1382-4376-2021-31-6-56-102.@@ Ивашкин В.Т., Маевская М.В., Жаркова М.С. и др. Клинические рекомендации Российского общества по изучению печени и Российской гастроэнтерологической ассоциации по диагностике и лечению фиброза и цирроза печени и их осложнений. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2021; 31(6): 56-102. doi: 10.22416/1382-4376-2021-31-6-56-102.

168. Nakaya Y., Harada N., Kakui S. et al. Severe catabolic state after prolonged fasting in cirrhotic patients: effect of oral branched-chain amino-acid-enriched nutrient mixture. Journal of gastroenterology. 2002; 37: 531-536. doi: 10.1007/s005350200082.

169. Khoroshilov I.E. Clinical nutrition and nutritional support. ELBI-SPb; 2018: 192. (In Russ.)@@ Хорошилов И.Е. Клиническое питание и нутриционная поддержка. ЭЛБИ-СПб; 2018: 192.

170. Khoroshilov I.E. Carnitine: a role in the human organism and the possibilities of therapeutic use in various diseases. Vrach. 2017; 3: 2-6. (In Russ.)@@ Хорошилов И.Е. Карнитин: роль в организме и возможности терапевтического применения при разных заболеваниях. Врач. 2017; 3: 2-6.

171. Plauth M., Bernal W., Dasarathy S. et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr. 2019; 38(2): 485-521. doi: 10.1016/j.clnu.2018.12.022.

172. Bendavid I., Singer P, Theilla M. et al. Nutrition Day ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr. 2017; 36(4): 1122-1129. doi: 10.1016/j.clnu.2016.07.012.

173. Van Dongen C., Paik J.M., Harring M. et al. Sarcopenia, healthy living, and mortality in patients with chronic liver diseases. Hepatol Commun. 2022; 6(11): 3140-3153. doi: 10.1002/hep4.2061.

174. Hanai T., Shiraki M., Nishimura K. et al. Sarcopenia impairs prognosis of patients with liver cirrhosis. Nutrition. 2015; 31: 193-199. doi: 10.1016/j.nut.2014.07.005.

175. Mantuano P., Boccanegra B., Bianchini G. et al. Branched-chain amino acids and di-alanine supplementation in aged mice: a translational study on sarcopenia. Nutrients. 2023; 15: 330. doi: 10.3390/nu15020330.

176. Mohta S., Anand A., Sharma S. et al. Randomised clinical trial: Effect of adding branched chain amino acids to exercise and standard-of-care on muscle mass in cirrhotic patients with sarcopenia. Hepatol Int. 2022; 16: 680-690. doi: 10.1007/s12072-022-10334-7.

177. Le Couteur D.G., Solon-Biet S.M., Cogger V.C. et al. Branched chain amino acids, aging and age-related health. Ageing Res Rev. 2020; 64: 101198. doi: 10.1016/j.arr.2020.101198.

178. Effect of BCAA Supplementation on Muscle Mass, Muscle Quality and Molecular Markers of Muscle Regeneration in CLD Patients (BCAA-CLD). Available at: https://clinicaltrials.gov/study/NCT04246918 Accessed: 01.02.2025.

179. Treatment of Sarcopenia Improves the Muscle Mass and Muscle Strength of Patients With Liver Cirrhosis-Child C. Available at: https://clinicaltrials.gov/study/NCT03633279 Accessed: 01.02.2025.

180. Uojima H. Sakurai S. Hidaka H. et al. Effect of branched-chain amino acid supplements on muscle strength and muscle mass in patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2017; 29(12): 1402-1407. doi: 10.1097/MEG.0000000000000968.

181. Marchesini G., Bianchi G., Merli M. et. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: A double-blind, randomized trial. Gastroenterology. 2003; 124: 1792-1801. doi: 10.1016/s0016-5085(03)00323-8.

182. Lattanzi B., Bruni A., Di Cola S. et al. The effects of 12-week beta-hydroxy-beta-methylbutyrate supplementation in patients with liver cirrhosis: Results from a randomized controlled single-blind pilot study. Nutrients. 2021; 13(7): 2296. doi: 10.3390/nu13072296.

183. Forbes S.C., Candow D.G., Ostojic S.M. et al. Meta-Analysis Examining the Importance of Creatine Ingestion Strategies on Lean Tissue Mass and Strength in Older Adults. Nutrients. 2021; 13: 1912. doi: 10.3390/nu13061912.

184. Casciola R., Leoni L., Cuffari B. et al. Creatine Supplementation to Improve Sarcopenia in Chronic Liver Disease: Facts and Perspectives. Nutrients. 2023; 15 (4): 863. doi: 10.3390/nu15040863.

185. McKendry J., Currier B.S., Lim C. et al. Nutritional Supplements to Support Resistance Exercise in Countering the Sarcopenia of Aging. Nutrients. 2020; 12: 2057. doi: 10.3390/nu12072057.

186. Dolan E., Artioli G.G., Pereira R.M.R., Gualano B. Muscular Atrophy and Sarcopenia in the Elderly: Is There a Role for Creatine Supplementation? Biomolecules. 2019; 9: 642. doi: 10.3390/biom9110642.

187. Troesch B., Eggersdorfer M., Laviano A. et al. Expert Opinion on Benefits of Long-Chain Omega-3 Fatty Acids (DHA and EPA) in Aging and Clinical Nutrition. Nutrients. 2020; 12: 2555. doi: 10.3390/nu12092555.

188. Noce A., Marrone G., Ottaviani E. et al. Uremic Sarcopenia and Its Possible Nutritional Approach. Nutrients. 2021; 13: 147. doi: 10.3390/nu13010147.

189. Xu D., Lu Y., Yang X. et al. Effects of fish oil-derived n-3 polyunsaturated fatty acid on body composition, muscle strength and physical performance in older people: A secondary analysis of a randomised, double-blind, placebo-controlled trial. Age Ageing. 2022; 51 doi: 10.1093/ageing/afac274.

190. Kraemer W.J., Volek J.S., French D.N. et al. The effects of L-carnitine L-tartrate supplementation on hormonal responses to resistance exercise and recovery. J Strength Cond Res. 2003; 17(3): 455-62. doi: 10.1519/1533-4287(2003)017<0455: teolls>2.0.co;2.

191. Methodological recommendations. Norms of physiological energy and nutritional requirements for various population groups of the Russian Federation. 2021. (In Russ.) Available at: https://www.garant.ru/products/ipo/prime/doc/402716140 Accessed: 01.02.2025.@@ Методические рекомендации. Нормы физиологических потребностей в энергии и пищевых веществах для различных групп населения Российской Федерации. 2021. https://www.garant.ru/products/ipo/prime/doc/402716140

192. Rondanelli M., Nichetti M., Peroni G. et al. Where to Find Leucine in Food and How to Feed Elderly with Sarcopenia in Order to Counteract Loss of Muscle Mass: Practical Advice. Front. Nutr. 2020; 7: 622391. doi: 10.3389/fnut.2020.622391.

193. Mellen R.H., Girotto O.S., Marques E.B. et al. Insights into Pathogenesis, Nutritional and Drug Approach in Sarcopenia: A Systematic Review. Biomedicines. 2023; 11(1): 136. doi: 10.3390/biomedicines11010136.

194. Lee Y.H., Jung K.S., Kim S.U. et al. Sarcopaenia is associated with NAFLD independently of obesity and insulin resistance: Nationwide surveys (KNHANES 2008-2011) J. Hepatol. 2015; 63: 486-493. doi: 10.1016/j.jhep.2015.02.051.

195. Pang Q., Qu K., Liu C. et al. Sarcopenia and nonalcoholic fatty liver disease: New evidence for low vitamin D status contributing to the link. Hepatology. 2016; 63: 675. doi: 10.1002/hep.28010.

196. Eliades M., Spyrou E., Agrawal N. et al. Meta-analysis: Vitamin D and non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2013; 38: 246-254. doi: 10.1111/apt.12377,

197. Tanaka K., Kanazawa I., Yamaguchi T. et al. Active vitamin D possesses beneficial effects on the interaction between muscle and bone. Biochem Biophys Res Commun. 2014; 450: 482-487. doi: 10.1016/j.bbrc.2014.05.145.

198. Hata R., Miyamoto K., Abe Y. et al. Osteoporosis and sarcopenia are associated with each other and reduced IGF1 levels are a risk for both diseases in the very old elderly. Bone. 2022; 166: 116570. doi: 10.1016/j.bone.2022.116570.

199. Papadopoulou S.K., Voulgaridou G., Kondyli F.S. et al. Nutritional and Nutrition-Related Biomarkers as Prognostic Factors of Sarcopenia, and Their Role in Disease Progression. Diseases. 2022; 10: 42. doi: 10.3390/diseases10030042.

200. Uchitomi R., Oyabu M., Kamei Y. Vitamin D and Sarcopenia: Potential of Vitamin D Supplementation in Sarcopenia Prevention and Treatment. Nutrients. 2020; 12: 3189. doi: 10.3390/nu12103189.

201. Vitamin D deficiency. Clinical recommendations.Russian Association of Endocrinologists. 2021; 56. (In Russ.)@@ Дефицит витамина D. Клинические рекомендации. Российская ассоциация эндокринологов. 2021; 56.

202. Yahfoufi N., Alsadi N., Jambi M., Matar C. The immunomodulatory and anti-inflammatory role of polyphenols. Nutrients. 2018; 10(11): 1618. doi: 10.3390/nu10111618.

203. Felice F., Cesare M.M., Fredianelli L. et al. Effect of tomato peel extract grown under drought stress condition in a sarcopenia model. Molecules. 2022; 27(8): 2563. doi: 10.3390/molecules27082563.

204. Funakoshi T., Kanzaki N., Otsuka Y. et al. Quercetin inhibits adipogenesis of muscle progenitor cells in vitro. Biochem Biophys Rep. 2017; 13: 39-44. doi: 10.1016/j.bbrep.2017.12.003.

205. Hartley L., Flowers N., Holmes J. et al. Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013; 2013(6): CD009934. doi: 10.1002/14651858.CD009934.pub2.

206. Rezaei S., Akhlaghi M., Sasani M.R., Barati R.B. Olive oil lessened fatty liver severity independent of cardiometabolic correction in patients with non-alcoholic fatty liver disease: a randomized clinical trial. Nutrition. 2019; 57: 154-161. doi: 10.1016/j.nut.2018.02.021.

207. Tarantino G., Sinatti G., Citro V. et al. Sarcopenia, a condition shared by various diseases: can we alleviate or delay the progression? Intern Emerg Med. 2023; 18(7): 1887-1895. doi: 10.1007/s11739-023-03339-z.

208. Yin Y., Guo Q., Zhou X. et al. Role of brain-gut-muscle axis in human health and energy homeostasis. Front Nutr. 2022; 9: 947033. doi: 10.3389/fnut.2022.947033.

209. Giron M., Thomas M., Dardevet D. et al. Gut microbes and muscle function: can probiotics make our muscles stronger? J Cachexia Sarcopenia Muscle. 2022; 13(3): 1460-1476. doi: 10.1002/jcsm.12964.

210. Scheele C., Nielsen S., Pedersen B.K. ROS and myokines promote muscle adaptation to exercise. Trends Endocrinol Metab. 2009; 20(3): 95-99. doi: 10.1016/j.tem.2008.12.002.

211. Nychas E., Marfil-Sánchez A., Chen X. et al. Discovery of robust and highly specific microbiome signatures of non-alcoholic fatty liver disease. Microbiome. 2025; 13, 10. doi: 10.1186/s40168-024-01990-y.

212. Pasta A., Formisano E., Calabrese F., Marabotto E., Furnari M., Bodini G., Torres M.C.P., Pisciotta L., Giannini E.G., Zentilin P. From Dysbiosis to Hepatic Inflammation: A Narrative Review on the Diet-Microbiota-Liver Axis in Steatotic Liver Disease. Microorganisms. 2025; 13, 241. doi: 10.3390/microorganisms13020241.

213. Wang H., Huang W.Y., Zhao Y. Efficacy of exercise on muscle function and physical performance in older adults with sarcopenia: an updated systematic review and meta-analysis.Int J Environ Res Public Health. 2022; 19(13): 8212. doi: 10.3390/ijerph19138212.

214. Vlietstra L., Hendrickx W., Waters D.L. Exercise interventions in healthy older adults with sarcopenia: A systematic review and meta-analysis. Australas J Ageing. 2018; 37(3): 169-183. doi: 10.1111/ajag.12521.

215. Beckwee, D., Delaere A., Aelbrecht S. et al. Exercise Interventions for the Prevention and Treatment of Sarcopenia. A Systematic Umbrella Review. J. Nutr. Health Aging. 2019; 23(6): 494-502. doi: 10.1007/s12603-019-1196-8.

216. Yoo S.Z., No M.H., Heo J.W. et al. Role of exercise in age-related sarcopenia. J. Exerc. Rehabil. 2018; 14(4): 551-558. doi: 10.12965/jer.1836268.134.

217. Bocalini D.S., Lima L.S., De Andrade S. et al. Effects of circuit-based exercise programs on the body composition of elderly obese women. Clin Interv Aging. 2012; 7: 551-556. doi: 10.2147/CIA.S33893.

218. Vieira F.T., de Oliveira G.S., Gonçalves V.S.S. et al. Effect of physical exercise on muscle strength in adults following bariatric surgery: A systematic review and meta-analysis of different muscle strength assessment tests. PLoS ONE. 2022; 17: e0269699. doi: 10.1371/journal.pone.0269699.

219. Chiu S.C., Yang R.S., Yang R.J., Chang S.F. Effects of resistance training on body composition and functional capacity among sarcopenic obese residents in long-term care facilities: A preliminary study. BMC Geriatr. 2018; 18: 21. doi: 10.1186/s12877-018-0714-6.

220. Park J., Kwon Y., Park H. Effects of 24-Week Aerobic and Resistance Training on Carotid Artery Intima-Media Thickness and Flow Velocity in Elderly Women with Sarcopenic Obesity. J Atheroscler Thromb. 2017; 24: 1117-1124. doi: 10.5551/jat.39065.

221. Maltais M.L., Perreault K., Courchesne-Loyer A. et al. Effect of Resistance Training and Various Sources of Protein Supplementation on Body Fat Mass and Metabolic Profile in Sarcopenic Overweight Older Adult Men: A Pilot Study.Int J Sport Nutr Exerc Metab. 2016; 26: 71-77. doi: 10.1123/ijsnem.2015-0160.

222. Trouwborst I., Verreijen A., Memelink R. et al. Exercise and Nutrition Strategies to Counteract Sarcopenic Obesity. Nutrients. 2018; 10: 605. doi: 10.3390/nu10050605.

223. Nabuco H.C., Tomeleri C.M., Fernandes R.R. et al. Effect of whey protein supplementation combined with resistance training on body composition, muscular strength, functional capacity, and plasma-metabolism biomarkers in older women with sarcopenic obesity: A randomized, double-blind, placebo-controlled trial. Clin. Nutr. ESPEN. 2019; 32: 88-95. doi: 10.1016/j.clnesp.2019.04.007.

224. Gonzalez A., Valero-Breton M., Huerta-Salgado C., et al. Impact of exercise training on the sarcopenia criteria in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Eur J Transl Myol. 2021; 31(1): 9630. doi: 10.4081/ejtm.2021.9630.

225. Nakatsuka T., Tateishi R., Koike K. Changing clinical management of NAFLD in Asia. Liver Int. 2021; 42(9): 1955-68. doi: 10.1111/liv.15046.

226. Arrese M., Cabello-Verrugio C., Arab J.P. et al. Sarcopenia in the setting of nonalcoholic fatty liver. Metab Target Org Damage. 2022; 2: 2. doi: 10.20517/mtod.2021.16.

227. Dietrich R., Bachmann C., Lauterburg B.H. Exercise-induced hyperammonemia in patients with compensated chronic liver disease. Scand J Gastroenterol. 1990; 25(4): 329-34. doi: 10.3109/00365529009095494.

228. Berzigotti A., Albillos A., Villanueva C. et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology. 2017; 65(4): 1293-1305. doi: 10.1002/hep.28992.

229. Hashida R., Kawaguchi T., Bekki M. et al. Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: A systematic review. J. Hepatol. 2017; 66: 142-152. doi: 10.1016/j.jhep.2016.08.023.

230. Lopes K.G., Bottino D.A., Farinatti P. et al. Strength training with blood flow restriction: A novel therapeutic approach for older adults with sarcopenia? A case report. Clin.Interv. Aging. 2019; 14: 1461-1469. doi: 10.2147/CIA.S206522.

231. Bahat G., Ozkok S. The current landscape of pharmacotherapies for sarcopenia. Drugs Aging. 2024; 41(2): 83-112. doi: 10.1007/s40266-023-01093-7.

232. Sinclair M., Grossmann M., Hoermann R. et al. Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone: A randomised controlled trial. J Hepatol. 2016; 65(5): 906-913. doi: 10.1016/j.jhep.2016.06.007.

233. Sinha-Hikim I., Taylor W.E., Gonzalez-Cadavid N.F. et al. Androgen receptor in human skeletal muscle and cultured muscle satellite cells: Up-regulation by androgen treatment. J. Clin. Endocrinol. Metab. 2004; 89(10): 5245-55. doi: 10.1210/jc.2004-0084.

234. Ali S.R., Nkembo A.T., Tipparaju S.M. et al. Sarcopenia: recent advances for detection, progression, and metabolic alterations along with therapeutic targets. Can J Physiol Pharmacol. 2024; 102(12): 697-708. doi: 10.1139/cjpp-2024-0201.

235. Tang M.N., Prendergast L.A., Dupuis P. et al. Effects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial. BMC Med. 2016; 14(1): 153. doi: 10.1186/s12916-016-0700-9.

236. Bruno B.J., Weavil J.C., Ogle J. et al. Oral LPCN 1148 improves sarcopenia and hepatic encephalopathy in male patients with cirrhosis: A randomized, placebo-controlled phase 2 trial. Hepatology. 2025. doi: 10.1097/HEP.0000000000001146.

237. Bian A., Ma Y., Zhou X. et al. Association between sarcopenia and levels of growth hormone and insulin-like growth factor-1 in the elderly. BMC Musculoskelet Disord. 2020; 21(1): 214. doi: 10.1186/s12891-020-03236-y.

238. Kaur M., Misra S. Bimagrumab: an investigational human monoclonal antibody against activin type II receptors for treating obesity. J Basic Clin Physiol Pharmacol. 2024; 35(6): 325-334. doi: 10.1515/jbcpp-2024-0065.

239. Stefanakis K., Kokkorakis M., Mantzoros C.S. The impact of weight loss on fat-free mass, muscle, bone and hematopoiesis health: Implications for emerging ph armacotherapies aiming at fat reduction and lean mass preservation. Metabolism. 2024; 161: 156057. doi: 10.1016/j.metabol.2024.156057.

240. Saitoh M., Ishida J., Ebner N. et al. Myostatin inhibitors as pharmacological treatment for muscle wasting and muscular dystrophy. J. Cachexia Sarcopenia Muscle Clin Rep. 2017; 2: 1-10.

241. Pearsall R.S., Davies M.V., Cannell M. et al. Follistatin-based ligand trap ACE-083 induces localized hypertrophy of skeletal muscle with functional improvement in models of neuromuscular disease. Sci. Rep. Sci Rep. 2019; 9(1): 11392. doi: 10.1038/s41598-019-47818-w.

242. Rolland Y., Dray C., Vellas B., Barreto P.S. Current and investigational medications for the treatment of sarcopenia. Metabolism. 2023; 149: 155597. doi: 10.1016/j.metabol.2023.155597.

243. Dabrowska S., Andrzejewska A., Lukomska B., Janowski M. Neuroinflammation as a target for treatment of stroke using mesenchymal stem cells and extracellular vesicles. J Neuroinflammation. 2019; 16(1):178. doi: 10.1186/s12974-019-1571-8.

244. Cunningham C.J., Redondo-Castro E., Allan S.M. The therapeutic potential of the mesenchymal stem cell secretome in ischaemic stroke. J Cereb Blood Flow Metab. 2018; 38(8): 1276-1292. doi: 10.1177/0271678X18776802.

245. Pourmohammadi-Bejarpasi Z., Roushandeh A.M., Saberi A. et al. Mesenchymal stem cells-derived mitochondria transplantation mitigates I/R-induced injury, abolishes I/R-induced apoptosis, and restores motor function in acute ischemia stroke rat model. Brain Res Bull. 2020; 165: 70-80. doi: 10.1016/j.brainresbull.2020.09.018.

246. Lo J.H.T., Pong U.K., Yiu T. et al. Sarcopenia: Current treatments and new regenerative therapeutic approaches. J Orthop Translat. 2020; 23: 38-52. doi: 10.1016/j.jot.2020.04.002.

247. Bielecka-Dabrowa A., Fabis J., Mikhailidis D.P. et al. Prosarcopenic effects of statins may limit their effectiveness in patients with heart failure. Trends Pharmacol Sci. 2018; 39(4): 331-353. doi: 10.1016/j.tips.2018.02.003.

248. Crisan E., Patil V.K. Neuromuscular complications of statin therapy. Curr Neurol Neurosci Rep. 2020; 20(10): 47. doi: 10.1007/s11910-020-01064-0.

249. Qaisar R., Khan I.M., Karim A. et al. Lipid-Lowering Medications are Associated with Reduced Sarcopenia-Related Quality of Life in Older Adults with Hyperlipidemia. Drugs Aging. 2024; 41(5): 443-453. doi: 10.1007/s40266-024-01111-2.

250. Valdiviesso R., Sousa-Santos A.R., Azevedo L.F. et al. Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study. BMC Cardiovasc Disord. 2022; 22(1): 356. doi: 10.1186/s12872-022-02804-5.

251. Huang S.T., Otsuka R., Nishita Y. et al. Risk of Sarcopenia Following Long-Term Statin Use in Community-Dwelling Middle-Aged and Older Adults in Japan. J Cachexia Sarcopenia Muscle. 2025; 16(1): e13660. doi: 10.1002/jcsm.13660.

252. Gorabi A.M., Kiaie N., Hajighasemi S. et al. Statin-induced nitric oxide signaling: mechanisms and therapeutic implications. J Clin Med. 2019; 8(12): 2051. doi: 10.3390/jcm8122051.

253. Amarasekera A.T., Chang D., Schwarz P., Tan T.C. Does vascular endothelial dysfunction play a role in physical frailty and sarcopenia? A systematic review. Age Ageing. 2021; 50(3): 725-732. doi: 10.1093/ageing/afaa237.

254. Sahebkar A., Kotani K., Serban C. et al. Statin therapy reduces plasma endothelin-1 concentrations: a meta-analysis of 15 randomized controlled trials. Atherosclerosis. 2015; 241(2): 433-442. doi: 10.1016/j.atherosclerosis.2015.05.022.

255. Kumar A., Davuluri G., Silva R.N.E., Engelen M. et al. Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis. Hepatology. 2017; 65(6): 2045-2058. doi: 10.1002/hep.29107.

256. Pichon C., Nachit M., Gillard J. et al. Impact of L-ornithine L-aspartate on non-alcoholic steatohepatitis-associated hyperammonemia and muscle alterations. Front Nutr. 2022; 9: 1051157. doi: 10.3389/fnut.2022.1051157.

257. Prikhodko V.A., Sysoev Yu.I., Poveryaeva M.A. et al. Effects of empagliflozin and L-ornithine L-aspartate on behavior, cognitive functions, and physical performance in mice with experimentally induced steatohepatitis. Bulletin of Russian State Medical University. 2020; (3): 49-57. doi: 10.24075/brsmu.2020.034.

258. Ostrovskaya A.S., Maevskaya M.V., Loban K.M. и др. Possibilities of treating sarcopenia in liver cirrhosis with hypoammonemic agents. Meditsinskiy sovet. 2024; 15: 51-60. (In Russ.) doi: 10.21518/ms2024-383.@@ Островская А.С., Маевская М.В., Лобан К.М. и др. Возможности лечения саркопении при циррозе печени гипоаммониемическими средствами. Медицинский Совет. 2024; 15: 51-60. doi: 10.21518/ms2024-383.

259. Statsenko M.E., Myazin R.G. Prospects for the treatment of various phenotypes of non-alcoholic fatty liver disease complicated by the development of hyperammonemia and sarcopenia: results of a clinical study. Bulletin of the Russian Military Medical Academy. 2025; 27 (1) (In Russ.) (in press).@@ Стаценко М.Е., Мязин Р.Г. Перспективы лечения различных фенотипов неалкогольной жировой болезни печени, осложненных развитием гипераммониемии и саркопении: результаты клинического исследования. Вестник Российской военно-медицинской академии. 2025; 27 (1) (в печати).

260. Butterworth R.F., Canbay A. Hepatoprotection by L-Ornithine L-Aspartate in Non-Alcoholic Fatty Liver Disease. Dig Dis. 2019; 37(1): 63-68. doi: 10.1159/000491429.

261. Loomba R., Abdelmalek M.F., Armstrong M.J. et al. Semaglutide 2,4 mg once weekly in patients with non-alcoholic steatohepatitis-related cirrhosis: a randomised, placebo-controlled phase 2 trial. Lancet Gastroenterol Hepatol. 2023; 8(6): 511-522. doi: 10.1016/S2468-1253(23)00068-7.

262. Neeland I.J., Linge J., Birkenfeld A.L. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes Obes Metab. 2024; 26(4): 16-27. doi: 10.1111/dom.15728.

263. Karakasis P., Patoulias D., Fragakis N., Mantzoros C.S. Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis. Metabolism. 2025; 164: 156113. doi: 10.1016/j.metabol.2024.156113.

264. Wei Q., Xu X., Guo L. et al. Effect of SGLT2 Inhibitors on Type 2 Diabetes Mellitus With Non-Alcoholic Fatty Liver Disease: A Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne). 2021; 12: 635556. doi: 10.3389/fendo.2021.635556.

265. Vallon V., Verma S. Effects of SGLT2 Inhibitors on Kidney and Cardiovascular Function. Annu. Rev. Physiol. 2021; 83: 503-528. doi: 10.1146/annurev-physiol-031620-095920.

266. Bamba R., Okamura T., Hashimoto Y. et al. Extracellular lipidome change by an SGLT2 inhibitor, luseogliflozin, contributes to prevent skeletal muscle atrophy in db/db mice. J Cachexia Sarcopenia Muscle. 2022; 13: 574-588. doi: 10.1002/jcsm.12814.

267. Otsuka H., Yokomizo H., Nakamura S. et al. Differential effect of canagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, on slow and fast skeletal muscles from nondiabetic mice. Biochem J. 2022; 479: 425-444. doi: 10.1042/BCJ20210700.

268. Sasaki T., Sugawara M., Fukuda M. Sodium-glucose cotransporter 2 inhibitor-induced changes in body composition and simultaneous changes in metabolic profile: 52-week prospective LIGHT (Luseogliflozin: The Components of Weight Loss in Japanese Patients with Type 2 Diabetes Mellitus) Study. J. Diabetes Investig. 2019; 10: 108-117. doi: 10.1111/jdi.12851.

269. Toledo-Pérez R., Lopéz-Cervantes S.P., Hernández-Álvarez D. et al. Metformin and tBHQ Treatment Combined with an Exercise Regime Prevents Osteosarcopenic Obesity in Middle-Aged Wistar Female Rats. Oxid. Med. Cell. Longev. 2021; 5294266. doi: 10.1155/2021/5294266.

270. Hernández-Álvarez D., Mena-Montes B., Toledo-Pérez R. et al. Long-Term Moderate Exercise Combined with Metformin Treatment Induces an Hormetic Response That Prevents Strength and Muscle Mass Loss in Old Female Wistar Rats. Oxid Med Cell Longev. 2019: 3428543. doi: 10.1155/2019/3428543.

271. Chen F., Xu S., Wang Y. et al. Risk Factors for Sarcopenia in the Elderly with Type 2 Diabetes Mellitus and the Effect of Metformin. J Diabetes Res. 2020; 3950404. doi: 10.1155/2020/3950404.

272. Laksmi P.W., Setiati S., Tamin T.Z. et al. Effect of Metformin on Handgrip Strength, Gait Speed, Myostatin Serum Level, and Health-related Quality of Life: A Double Blind Randomized Controlled Trial among Non-diabetic Pre-frail Elderly Patients. Acta Med Indones. 2017; 49: 118-127.

273. Sencan C., Dost F.S., Ates Bulut E., Isik A.T. DPP4 inhibitors as a potential therapeutic option for sarcopenia: A 6-month follow-up study in diabetic older patients. Exp Gerontol. 2022; 164: 111832. doi: 10.1016/j.exger.2022.111832.

274. Bouchi R., Fukuda T., Takeuchi T. et al. Dipeptidyl peptidase 4 inhibitors attenuates the decline of skeletal muscle mass in patients with type 2 diabetes. Diabetes Metab Res Rev. 2018; 34: e2957. doi: 10.1002/dmrr.2957.

275. Burks T.N., Andres-Mateos E., Marx R. et al. Losartan restores skeletal muscle remodeling and protects against disuse atrophy in sarcopenia. SciTransl. Med. 2011; 3: 82ra37. doi: 10.1126/scitranslmed.3002227.

276. Takeda S., Kaji K., Nishimura N. et al. Angiotensin Receptor Blockers Potentiate the Protective Effect of Branched-Chain Amino Acids on Skeletal Muscle Atrophy in Cirrhotic Rats. Mol Nutr Food Res. 2021; 65: e2100526. doi: 10.1002/mnfr.202100526.

277. Pahor M., Anton S.D., Beavers D.P. et al. Effect of Losartan and Fish Oil on Plasma IL-6 and Mobility in Older Persons. The ENRGISE Pilot Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci. 2019; 74: 1612-1619. doi: 10.1093/gerona/gly27.

278. Akhmedov V.A., Isaeva A.S., Marinenko V.S. Modern views on the management tactics of patients with sarcopenia in combination with non-alcoholic fatty liver disease. Lechaschi Vrach. 2024; 8(27): 29-34. (In Russ.) doi: 10.51793/OS.2024.27.8.004.@@ Ахмедов В.А., Исаева А.С., Мариненко В.С. Современные взгляды на тактику ведения пациентов с саркопенией в сочетании с неалкогольной жировой болезнью печени. Лечащий Врач. 2024; 8(27): 29-34. doi: 10.51793/OS.2024.27.8.004.