Can L-carnitine supplementation and exercise improve muscle complications in patients with liver cirrhosis who receive branched-chain amino acid supplementation?

Eur J Gastroenterol Hepatol. 2019 Jul;31(7):878-884. doi: 10.1097/MEG.0000000000001368.


Background: The aim of this study was to elucidate the efficacy of the combination of L-carnitine and exercise, reported to prevent muscle wasting, for muscle complications (function, volume, and cramping) in patients with liver cirrhosis (LC) who received branched-chain amino acid supplementation.

Materials and methods: From December 2017 to April 2018, 18 patients with LC who had been given branched-chain amino acid granule supplementation (12.45 g/day) were enrolled (mean age 68.4±10.8 years; 10 males and eight females; Child-Pugh A : B=9 : 9). After evaluating the average number of daily steps, oral L-carnitine supplementation (1000 mg/day) and additional exercise (plus 2000 steps/day) were added for 6 months. Every 4 weeks, a pedometer, a hand dynamometer, ergometer, and bioelectrical impedance analysis were used to evaluate daily steps, muscle function and muscle volume, and muscle cramps were recorded using a numerical rating scale.

Results: Average steps and serum levels of total and free carnitine were increased from before treatment to the final measurement (1883.5±1211.6 vs. 3165.1±1800.0/day, 62.6±16.5 vs. 110.9±28.6 μmol/l, and 47.7±15.2 vs. 83.2±21.5 μmol/l, respectively; P<0.01), whereas there were no significant changes in the ratios of handgrip strength, leg strength, and muscle volume after 6 months [1.00±0.13 (P=0.991), 1.07±0.13 (P=0.073), and 0.992±0.036 (P=0.390), respectively]. However, the frequency of complaints of muscle cramping was reduced as compared with the start of therapy (baseline, 3 months, and 6 months: 6.3±4.8, 3.1±3.3, and 2.1±2.0, respectively) (P=0.025, Holm's method), whereas numerical rating scale did not show any significant improvement.

Conclusion: L-Carnitine may have an important role for prevention of muscle wasting and reducing the frequency of muscle cramping.

MeSH terms

  • Aged
  • Amino Acids, Branched-Chain / therapeutic use*
  • Carnitine / therapeutic use*
  • Dietary Supplements
  • Electric Impedance
  • Exercise Therapy / methods*
  • Female
  • Hand Strength
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / therapy*
  • Male
  • Middle Aged
  • Muscle Cramp / etiology
  • Muscle Cramp / physiopathology
  • Muscle Cramp / prevention & control*
  • Muscle Strength / physiology
  • Muscle Strength Dynamometer
  • Muscle Weakness / etiology
  • Muscle Weakness / physiopathology
  • Muscle Weakness / therapy*
  • Muscle, Skeletal / pathology
  • Muscle, Skeletal / physiopathology
  • Muscular Atrophy / etiology
  • Muscular Atrophy / physiopathology
  • Muscular Atrophy / prevention & control*
  • Organ Size
  • Sarcopenia / etiology
  • Sarcopenia / physiopathology
  • Sarcopenia / therapy*


  • Amino Acids, Branched-Chain
  • Carnitine