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Sinanoğlu MS, Güngör Ş, Dağ N, Varol Fİ, Kenç Ş, Gök E. Ultrasound and shear wave elastography assessment of diaphragm thickness and stiffness in malnourished pediatric patients. Eur J Pediatr 2024; 184:35. [PMID: 39567388 DOI: 10.1007/s00431-024-05852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 10/04/2024] [Accepted: 10/20/2024] [Indexed: 11/22/2024]
Abstract
Our objective was to obtain information about diaphragm muscle mass, strength, and quality using conventional US and US-based imaging method shear wave elastography (SWE) in pediatric patients with primary malnutrition. We also sought to evaluate the usability of SWE in the diagnosis and follow-up of sarcopenia. We evaluated the diaphragm thickness and stiffness of patients diagnosed with primary malnutrition in the pediatrics and pediatric gastroenterology outpatient clinic using US and US-based SWE. The data were compared with those of an age- and gender-matched healthy control group. The study included 115 volunteers. Of the cases included, 53 were healthy controls and 62 (54%) were patients with primary malnutrition. There was no significant difference between the groups in terms of age and gender (p = 0.891 and p = 0.923, respectively). The malnourished patient group had significantly lower diaphragm thickness and stiffness. There is a significant positive correlation between anthropometric measurement Z scores and diaphragm thickness and stiffness. CONCLUSION Our study indicated that there was a reduction in the thickness of the diaphragm and a decline in its stiffness, which could be an indirect indicator of the quality and strength of the diaphragm muscle. These findings suggest that US and SWE evaluation of the diaphragm muscle may have the potential for use in the diagnosis and follow-up of sarcopenia. However, further comprehensive randomized controlled studies are needed to confirm this. WHAT IS KNOWN • Magnetic resonance imaging, computed tomography, and dual-energy x-ray absorptiometry are commonly used in the evaluation of sarcopenia. • The psoas and paraspinal muscles are commonly used in the evaluation of sarcopenia. WHAT IS NEW • Ultrasound and shear wave elastography can be used in the evaluation of pediatric sarcopenia. • Diaphragm muscle can be used in the evaluation of pediatric sarcopenia.
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Affiliation(s)
- M Selçuk Sinanoğlu
- Department of Child Health and Diseases, Malatya Turgut Ozal University Education and Research Hospital, Malatya, Turkey
| | - Şükrü Güngör
- Department of Pediatric Gastroenterology, School of Medicine, İnonu University, Malatya, Turkey.
| | - Nurullah Dağ
- Department of Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Fatma İlknur Varol
- Department of Pediatric Gastroenterology, School of Medicine, İnonu University, Malatya, Turkey
| | - Şenay Kenç
- Department of Pediatric Gastroenterology, Malatya Turgut Ozal University, Education and Research Hospital, Malatya, Turkey
| | - Emre Gök
- Department of Pediatric Gastroenterology, School of Medicine, İnonu University, Malatya, Turkey
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Inoue T, Wakabayashi H, Kawase F, Kokura Y, Takamasu T, Fujiwara D, Maeda K. Diagnostic criteria, prevalence, and clinical outcomes of pediatric sarcopenia: A scoping review. Clin Nutr 2024; 43:1825-1843. [PMID: 38959660 DOI: 10.1016/j.clnu.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND & AIMS Sarcopenia, characterized by loss of muscle mass and decreased muscle strength, significantly affects adults but also influences pediatric health. However, definitions for low muscle mass, decreased strength, and sarcopenia in children are less established, impacting interventions for improving health outcomes. The objective of this scoping review is synthesize the existing literature on the diagnostic criteria, prevalence and clinical outcomes of sarcopenia. METHODS A scoping review, following the PRISMA extension for scoping reviews, examined pediatric sarcopenia literature until June 2023. The literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials with the last search conducted on June 30, 2023. Criteria included studies on aged 0-20 years, covering healthy subjects, acutely ill patients, and chronic disease cases excluding specific conditions like neuromuscular diseases or prematurity. RESULTS Initial search found 503 studies, finally, we included 56 studies. Most studies diagnosed sarcopenia using skeletal muscle mass indicators like total psoas muscle area from Computed Tomography or Magnetic Resonance Imaging. Around half of the longitudinal studies highlighted sarcopenia as a risk factor for various clinical outcomes, predominantly in hospitalized patients. However, cutoff values for sarcopenia indicators lacked consistency, with studies employing diverse percentile-based measurements or z-scores. CONCLUSION Pediatric sarcopenia diagnosis primarily relies on skeletal muscle mass, with identified links to future clinical outcomes in specific conditions. The lack of standardized cutoffs for sarcopenia indicators underscores the necessity for age, gender, and race-specific cutoff values derived from studies establishing reference values for muscle mass and strength across diverse pediatric populations.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan
| | - Fumiya Kawase
- Department of Nutrition, Asuke Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Aichi, Japan.
| | - Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-term Care, Hosu, Japan.
| | - Tetsuya Takamasu
- Department of Community Health Promotion, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan.
| | - Dai Fujiwara
- Department of Rehabilitation Medicine, Saka General Hospital, Shiogama, 985-8506, Japan.
| | - Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Aichi, Japan.
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Veraldi S, Pietrobattista A, Soglia G, Monti L, Alterio T, Mosca A, Liccardo D, Basso MS, Della Corte C, Russo L, Candusso M, Chiusolo F, Tortora F, Spada M, Maggiore G. Sarcopenia in children with chronic liver disease: Prevalence and impact on liver transplant outcomes. Front Pediatr 2022; 10:1033570. [PMID: 36741094 PMCID: PMC9891232 DOI: 10.3389/fped.2022.1033570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Sarcopenia is a clinical condition characterized by a reduction in muscle mass, which typically affects adult patients; however, it has recently been recognized in pediatric literature. Few studies in children with chronic liver disease (CLD) undergoing liver transplantation (LT) have investigated the role of sarcopenia, with controversial results. The aim of our study was to assess the prevalence and impact of sarcopenia among children with CLD who are candidates for LT. We conducted a retrospective, single-center study at Bambino Gesù Children's Hospital (Rome, Italy) from July 2016 to July 2021, evaluating all children (0-16 years old) with CLD listed for LT with an abdomen computed tomography imaging available before LT. The total psoas muscle surface area (t-PMSA) was defined as the sum of left and right psoas muscle surface area measured at L4-L5 on axial images. The t-PMSA z-score was calculated according to reference data, and sarcopenia was defined as a t-PMSA z-score of ≤-2 (1-16 years) or a psoas muscle index [PMI; PMI = t-PMSA/(100 × BSA)] of <50th percentile of the population examined (<1 year). Clinical, laboratory, and LT outcome data were collected from all the patients with CLD. 27 out 48 (56%) of the patients aged 1-16 years were sarcopenic. No differences were noted in anthropometrics, nutritional support, liver function tests, model for ESLD (MELD), or pediatric ESLD (PELD) scores between patients with and without sarcopenia. The former showed a higher prevalence of respiratory complications (66.7% vs. 42.1%) and need for inotropes (40.7% vs. 10.8%) after LT. Among patients aged 0-1 years (n: 36), those with reduced muscle mass (50%) had a longer hospitalization time (44 vs. 24 days) and higher incidences of multi-organ failure syndrome (38.9% vs. 0%) and intensive care unit-related infections (61.1% vs. 27.8%) compared to those with greater muscle mass. t-PMSA and PMI were statistically significant predictors of LT outcomes. Sarcopenia is a reliable index of frailty in children with CLD, as its presence is associated with the risk of a more challenging LT. Future studies will have to investigate the functional aspects of sarcopenia and conceive preventive measures of muscle wasting in CLD patients.
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Affiliation(s)
- Silvio Veraldi
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.,Department of Anatomical, Histological, Forensic and Locomotor Apparatus Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Pietrobattista
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giovanna Soglia
- Department of Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Lidia Monti
- Department of Radiology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Tommaso Alterio
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Antonella Mosca
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Daniela Liccardo
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Sole Basso
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Claudia Della Corte
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luca Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCSS, Rome, Italy
| | - Manila Candusso
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Fabrizio Chiusolo
- Anesthesia and Critical Care Medicine, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Francesca Tortora
- Anesthesia and Critical Care Medicine, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giuseppe Maggiore
- Hepatology, Gastroenterology, Nutrition, and Liver Transplantation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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