Role of gut microbiota modulation in preventing and treating sarcopenia in patients with liver cirrhosis: A narrative review

Sarcopenia, a common and serious complication in patients with liver cirrhosis, is associated with high morbidity and mortality. Accumulating evidence highlights the gut-liver-muscle axis as a key regulatory pathway underlying muscle wasting in cirrhosis, with disruptions in the gut microbiome taking center stage. This review systematically summarizes the mechanisms by which gut microbiota dysregulation contributes to sarcopenia in cirrhosis, examining how compromised intestinal integrity, inflammatory responses, and disrupted metabolism of key compounds, such as short-chain fatty acids, branched-chain amino acids, and bile acids, play pivotal roles in this pathological process. We also critically examine the scientific evidence supporting approaches that target gut microbiome health, aiming to provide a comprehensive and up-to-date overview for clinicians and researchers.