| Management of Obesity in Liver Cirrhosis: A Delicate Balance of Risks and Benefits |
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Seung Kak Shin, Oh Sang Kwon |
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Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea |
| 간경변증에서의 비만 관리: 위험과 이득 사이의 균형 |
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신승각, 권오상 |
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가천대학교 의과대학 가천대 길병원 소화기내과 |
Correspondence:
Oh Sang Kwon, Tel: +82-32-460-3778, Fax: +82-32-460-3408, Email: kos@gilhospital.com
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Received: 10 March 2026 • Revised: 24 May 2026 • Accepted: 6 July 2026 |
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| Abstract |
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Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major global cause of chronic liver disease and is closely associated with obesity and metabolic syndrome. Obesity contributes to MASLD progression and increases the risk of liver fibrosis, cirrhosis, and hepatocellular carcinoma. However, the management of obesity in patients with cirrhosis is complex, as the catabolic state characteristic of cirrhosis predisposes patients to sarcopenia, malnutrition, and frailty. Excessive weight reduction may therefore worsen muscle loss and adversely affect clinical outcomes. Accordingly, obesity management in cirrhosis should prioritize not only weight reduction but also optimizing body composition by preserving muscle mass and physical function. A comprehensive assessment of nutritional status, sarcopenia, and frailty is essential before initiating weight management strategies. Lifestyle interventions are the cornerstone of therapy and include individualized nutritional support and exercise programs. Moderate caloric restriction with adequate protein intake is recommended for patients with compensated cirrhosis, whereas maintenance of nutritional status is prioritized in those with sarcopenia or decompensated cirrhosis. Pharmacological therapies, such as glucagon-like peptide-1 receptor agonists, demonstrate potential benefits in MASLD; however, evidence in established cirrhosis remains limited. Bariatric surgery should be considered in carefully selected patients with compensated cirrhosis. Overall, obesity management in MASLD-related cirrhosis requires an individualized, multidisciplinary approach. |
| Key Words:
Liver cirrhosis; Obesity; Metabolic dysfunction-associated steatotic liver disease; Sarcopenia; Frailty |
| 주제어:
간경변증; 비만; 대사이상지방간질환; 근감소증; 노쇠 |
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