Prospects for the treatment of different phenotypes of nonalcoholic fatty liver disease complicated by hyperammonemia and sarcopenia: clinical study results

Background: This study examined the effect of lowering ammonia levels on sarcopenia severity in patients receiving pharmacotherapy for different nonalcoholic fatty liver disease (NAFLD) phenotypes. Materials and methods: Moreover, it identified the optimal treatment strategy for managing these comorbid conditions. This single-center, prospective, observational clinical study included 30 adult patients diagnosed with different forms of NAFLD (i.e., steatosis, steatohepatitis, fibrosis, and cirrhosis) who had elevated blood ammonia levels and exhibited signs of sarcopenia. The participants were divided into two groups, which included 15 patients each. Group 1 received standard treatment plus L-ornithine-L-aspartate (9 g/day orally), whereas group 2 received standard treatment alone. The treatment course lasted 4 weeks. Results: The addition of L-ornithine-L-aspartate to standard therapy significantly reduced ammonia levels and improved sarcopenia markers in patients with NAFLD. The study confirmed previous evidence on the role of L-ornithine-L-aspartate in reducing hyperammonemia and hepatic encephalopathy in patients with NAFLD. Moreover, the findings showed sarcopenia regression in patients with NAFLD, including those without cirrhosis, following L-ornithine-L-aspartate intake for 4 weeks at a dose of 9 g/day. Conclusions: Thus, ammonia-lowering agents, such as L-ornithine-L-aspartate, show promise. However, large-scale clinical trials are required to confirm their effectiveness in improving muscle strength loss and hyperammonemia. Further analysis of the relationship between NAFLD, sarcopenia, and hyperammonemia may lead to the development of personalized therapeutic strategies integrating pharmacologic treatments with lifestyle modifications. Addressing these issues through early diagnosis, targeted therapy, and interdisciplinary approaches is crucial for improving patient outcomes.