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Dajti E, Rodrigues SG, Perazza F, Colecchia L, Marasco G, Renzulli M, Barbara G, Azzaroli F, Berzigotti A, Colecchia A, Ravaioli F. Sarcopenia evaluated by EASL/AASLD computed tomography-based criteria predicts mortality in patients with cirrhosis: A systematic review and meta-analysis. JHEP Rep 2024; 6:101113. [PMID: 39035068 PMCID: PMC11259801 DOI: 10.1016/j.jhepr.2024.101113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/03/2024] [Accepted: 04/24/2024] [Indexed: 07/23/2024] Open
Abstract
Background & Aims Sarcopenia is associated with increased morbidity and mortality in patients with cirrhosis, but its definition in current literature is very heterogeneous. We performed a systematic review and meta-analysis to assess the association between mortality and sarcopenia evaluated by computed tomography (CT) in patients with cirrhosis, both overall and stratified for the criteria used to define sarcopenia. Methods Medline, Embase, Scopus, and Cochrane Library were searched up to January 2023. We included studies assessing sarcopenia presence with CT scans and providing data on the risk of mortality. Adjusted hazard ratios (HRs) and 95% CIs were pooled using a random-effects model. Results Thirty-nine studies comprising 12,827 patients were included in the meta-analysis. The summary prevalence of sarcopenia was 44% (95% CI 38-50%). The presence of sarcopenia (any definition) was an independent predictor of mortality with an adjusted HR of 2.07 (95% CI 1.81-2.36), and the result was consistent in all subgroup analyses. The prognostic role of the EASL/AASLD criteria was confirmed for the first time with an HR of 1.86 (95% CI 1.53-2.26) (n = 14 studies). The cut-offs used to define sarcopenia based on psoas muscle parameters varied among studies, thus, a subgroup analysis was not feasible. There was no substantial heterogeneity for the main estimates and no significant risk of publication bias. Conclusions Sarcopenia on CT is associated with a 2-fold higher risk of mortality in patients with cirrhosis. The cut-offs proposed by EASL/AASLD are prognostically relevant and should be the recommended criteria used to define sarcopenia in clinical practice. Impact and implications Sarcopenia assessed by the reference standard (computed tomography scan) is an independent predictor of mortality in patients with cirrhosis, with a 2-fold increase in the risk of death in all sensitivity analyses. This finding is particularly valid in patients from Europe and North America, and in transplant candidates. Stratifying for the parameters and cut-offs used, we confirmed for the first time the prognostic impact of the definition proposed by EASL/AASLD, supporting their use in clinical practice. Psoas muscle assessment is promising, but data are still limited and too heterogeneous to recommend its routine use at present.
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Affiliation(s)
- Elton Dajti
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Susana G. Rodrigues
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Federica Perazza
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luigi Colecchia
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Barbara
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Antonio Colecchia
- Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Endo K, Kakisaka K, Abe T, Yusa K, Nakaya I, Watanabe T, Suzuki A, Yoshida Y, Oikawa T, Miyasaka A, Kuroda H, Matsumoto T. Positive impact of obesity on the prognosis of liver cirrhosis. J Gastroenterol Hepatol 2024; 39:1663-1672. [PMID: 38700075 DOI: 10.1111/jgh.16590] [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: 01/09/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND AIM The study aims to determine the prognostic impact of obesity, sarcopenic obesity, and dynapenic obesity in patients with chronic liver disease. METHODS This retrospective observational study enrolled patients with chronic hepatitis (n = 746) and liver cirrhosis (n = 434) without hepatocellular carcinoma at entry. The patients were evaluated for sarcopenia and obesity between April 2016 and April 2022. Obesity was defined as a body mass index of ≥ 25 kg/m2. Sarcopenic obesity was defined as low skeletal muscle mass (pre-sarcopenia) with obesity and dynapenic obesity was defined as low muscle strength (dynapenia) with obesity. The effects of obesity on survival were evaluated retrospectively. RESULTS The mean observation period was 2.5 years. Obesity, sarcopenic obesity, and dynapenic obesity were found in 271 (45.5%), 17 (2.9%), and 21 (3.5%) men, and 261 (44.7%), 59 (10.1%), and 53 (9.1%) women, respectively. A multivariate Cox proportional hazards model revealed that Child-Pugh class, dynapenia (hazard ratio [HR] 3.89), elderly (≥ 65 years old) (HR 2.11), and obesity (HR 0.58) were independently associated with overall survival (OS). However, neither sarcopenic nor dynapenic obesity were associated with OS. In patients with cirrhosis, the OS of the obese group was significantly higher than that of the non-obese group. The effect of obesity on OS was significant in elderly patients, but not in younger patients. CONCLUSIONS Sarcopenic and dynapenic obesity seem unrelated to the prognosis of patients with chronic liver disease. Obesity has a positive effect on the prognosis of elderly patients with cirrhosis.
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Affiliation(s)
- Kei Endo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Keisuke Kakisaka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Tamami Abe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Kenji Yusa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Ippeki Nakaya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Takuya Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Akiko Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Yuichi Yoshida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Takayoshi Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Akio Miyasaka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
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Correia J, Estevinho MM, Mesquita P, Gomes LC, Silva AP, Fernandes S, Rodrigues J, Afecto E, Freitas T. Are sarcopenia, frailty and malnutrition prognostic markers of liver disease decompensation in the ambulatory setting? - A prospective cohort study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:250-257. [PMID: 38095223 DOI: 10.17235/reed.2023.9907/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND sarcopenia, frailty and malnutrition are associated with adverse outcomes in liver cirrhosis. Studies assessing the prognostic value of these conditions in ambulatory patients with cirrhosis are scarce. METHODS a prospective cohort study was performed, with consecutive inclusion of all patients with cirrhosis observed in the Hepatology outpatient clinic of a Portuguese tertiary center. At study enrolment, evaluation of muscle mass (ultrasound quadriceps femoris thickness), muscle strength (handgrip dynamometry) and nutritional status (Patient-Generated Subjective Global Assessment Short Form) were performed. Follow-up ended upon the occurrence of a composite endpoint, comprising of liver decompensation events and liver-related death, or last medical appointment/non-liver related death before the end of the study. The prognostic value of anthropometrical parameters and nutritional status in the composite endpoint was assessed using a multivariate Cox regression analysis, adjusted for several confounders. RESULTS ninety patients were enrolled (80 % male), with a mean age of 63.5 ± 10.5 years. The median follow-up was 30 (interquartile range 38) weeks, during which, 12 patients reached the composite endpoint. These patients presented a lower mean handgrip strength (23.1 ± 6.41 vs 30.3 ± 10.4 kg, p = 0.04) compared to patients who did not reach the composite endpoint. However, Cox regression multivariate analysis did not find any independent predictors of the composite endpoint, apart from previous decompensation episodes. CONCLUSION in this study, muscle strength was lower in the group of patients with cirrhosis who presented a liver-related event. Handgrip strength might be a promising tool in the ambulatory setting to identify patients at risk of liver decompensation and liver-related death in the short term.
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Affiliation(s)
- João Correia
- Gastrenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | | | - Pedro Mesquita
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho
| | - Luís Correia Gomes
- Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil
| | - Ana Paula Silva
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho
| | - Sónia Fernandes
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho
| | - Jaime Rodrigues
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho
| | - Edgar Afecto
- Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Teresa Freitas
- Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho
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Mendez-Guerrero O, Carranza-Carrasco A, Chi-Cervera LA, Torre A, Navarro-Alvarez N. Optimizing nutrition in hepatic cirrhosis: A comprehensive assessment and care approach. World J Gastroenterol 2024; 30:1313-1328. [PMID: 38596498 PMCID: PMC11000076 DOI: 10.3748/wjg.v30.i10.1313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024] Open
Abstract
Cirrhosis is considered a growing cause of morbidity and mortality, which represents a significant public health problem. Currently, there is no effective treatment to reverse cirrhosis. Treatment primarily centers on addressing the underlying liver condition, monitoring, and managing portal hypertension-related complications, and evaluating the potential for liver transplantation in cases of decompensated cirrhosis, marked by rapid progression and the emergence of complications like variceal bleeding, hepatic encephalopathy, ascites, malnutrition, and more. Malnutrition, a prevalent complication across all disease stages, is often underdiagnosed in cirrhosis due to the complexities of nutritional assessment in patients with fluid retention and/or obesity, despite its crucial impact on prognosis. Increasing emphasis has been placed on the collaboration of nutritionists within hepatology and Liver transplant teams to deliver comprehensive care, a practice that has shown to improve outcomes. This review covers appropriate screening and assessment methods for evaluating the nutritional status of this population, diagnostic approaches for malnutrition, and context-specific nutrition treatments. It also discusses evidence-based recommendations for supplementation and physical exercise, both essential elements of the standard care provided to cirrhotic patients.
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Affiliation(s)
- Osvely Mendez-Guerrero
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Anaisa Carranza-Carrasco
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Luis Alberto Chi-Cervera
- Clínica de Especialidades Gastrointestinales y Hepáticas, Hospital Star Medica, Merida 97133, Yucatan, Mexico
| | - Aldo Torre
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Nalu Navarro-Alvarez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
- Molecular Biology, Universidad Panamericana School of Medicine, Campus México, Mexico City 03920, Mexico
- Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO 80045, United States
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Terbah R, Testro A, Gow P, Majumdar A, Sinclair M. Portal Hypertension in Malnutrition and Sarcopenia in Decompensated Cirrhosis-Pathogenesis, Implications and Therapeutic Opportunities. Nutrients 2023; 16:35. [PMID: 38201864 PMCID: PMC10780673 DOI: 10.3390/nu16010035] [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: 12/03/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Malnutrition and sarcopenia are highly prevalent in patients with decompensated cirrhosis and are associated with poorer clinical outcomes. Their pathophysiology is complex and multifactorial, with protein-calorie malnutrition, systemic inflammation, reduced glycogen stores and hormonal imbalances all well reported. The direct contribution of portal hypertension to these driving factors is however not widely documented in the literature. This review details the specific mechanisms by which portal hypertension directly contributes to the development of malnutrition and sarcopenia in cirrhosis. We summarise the existing literature describing treatment strategies that specifically aim to reduce portal pressures and their impact on nutritional and muscle outcomes, which is particularly relevant to those with end-stage disease awaiting liver transplantation.
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Affiliation(s)
- Ryma Terbah
- Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; (R.T.); (A.T.); (P.G.); (A.M.)
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Adam Testro
- Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; (R.T.); (A.T.); (P.G.); (A.M.)
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; (R.T.); (A.T.); (P.G.); (A.M.)
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Avik Majumdar
- Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; (R.T.); (A.T.); (P.G.); (A.M.)
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
| | - Marie Sinclair
- Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia; (R.T.); (A.T.); (P.G.); (A.M.)
- Department of Medicine, The University of Melbourne, Parkville, VIC 3050, Australia
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Sun C, Zhao T, Yang W, Guo G, Wang H, Li C, Hui Y, Cui B, Wang X, Fan X, Zhao X. Reduced muscle strength is closely linked to computed tomography-defined myosteatosis among inpatients with cirrhosis. Postgrad Med J 2023; 100:12-19. [PMID: 37827533 DOI: 10.1093/postmj/qgad097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/20/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Myosteatosis indicates pathological fat infiltration in muscles and is regarded as a distinct disease from sarcopenia. This muscular condition exhibits a link to muscle fiber disarrangement coinciding with disrupted muscle contractility and weakened mechanical action, mirrored as decreased muscle quality. However, the relationship between handgrip strength (HGS) and computed tomography-defined myosteatosis among cirrhosis is unclear. We aimed to investigate the association between HGS and myosteatosis and determine gender-specific cutoffs regarding HGS to identify myosteatotic subjects. METHODS We prospectively recruited 221 cirrhotic patients. The presence of myosteatosis was determined according to intramuscular adipose tissue content. The relationship between HGS and myosteatosis was evaluated according to Spearman correlation coefficient, area under the ROC curve, and multivariate logistic regression analysis. Moreover, a model based on the classification and regression tree method was generated. RESULTS Our results showed that HGS exhibits modestly negative correlation with intramuscular adipose tissue content in the entire cohort (rs = -0.269, P < .001) and across diverse subgroups precluding extremely deteriorating conditions. After controlling for multiple clinical features and biochemical parameters, HGS (odds ratio = 0.921, P = .010) was independently associated with myosteatosis in addition to age and body mass index. On applying the Japan Society of Hepatology-recommended cutoffs, an area under the ROC curve of HGS was 0.627 with a sensitivity of 77.4% and a specificity of 47.9%. The decision tree including body mass index and low HGS correctly classified ~85% of the cases in development and validation sets. CONCLUSIONS HGS was in close relation to myosteatosis among inpatients with cirrhosis.
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Affiliation(s)
- Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital , Anshan Road 154, Heping District, Tianjin 300052, China
| | - Tianming Zhao
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Jiangsu, Nanjing, 210008, China
| | - Wanting Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital , Anshan Road 154, Heping District, Tianjin 300052, China
| | - Gaoyue Guo
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital , Anshan Road 154, Heping District, Tianjin 300052, China
| | - Han Wang
- Department of Health Management, Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin 300211, China
| | - Chaoqun Li
- Department of Internal Medicine, Tianjin Hexi Hospital, Qiongzhou Road 43, Hexi District, Tianjin 300202, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital , Anshan Road 154, Heping District, Tianjin 300052, China
| | - Binxin Cui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, East Street 6, Tianjin Airport Economic Area, Tianjin 300308, China
| | - Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital , Anshan Road 154, Heping District, Tianjin 300052, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital , Anshan Road 154, Heping District, Tianjin 300052, China
| | - Xingliang Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, Tianjin 300052, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital , Anshan Road 154, Heping District, Tianjin 300052, China
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Guo G, Yang W, Wang S, Hui Y, Cui B, Wang X, Li C, Mao L, Fan X, Sun C. Handgrip strength is a substitutive metric to the GLIM criteria-defined malnutrition and predicts long-term mortality among hospitalized patients with cirrhosis. Nutr Clin Pract 2023; 38:1021-1031. [PMID: 37004207 DOI: 10.1002/ncp.10983] [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: 10/13/2022] [Revised: 02/04/2023] [Accepted: 02/26/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Hospitalized patients with cirrhosis are prone to debilitating health conditions and fluid fluctuations, posing barriers to accurately obtain anthropometric measures and physical examinations as surrogates for muscle mass within the Global Leadership Initiative on Malnutrition (GLIM). We hypothesize the handgrip strength (HGS) would serve as a substitutive metric, by comparing the diagnostic consistency and prognostic accuracy with computed tomography-demarcated skeletal muscle index (SMI)-defined malnutrition according to the GLIM criteria. METHODS Patients with cirrhosis underwent a two-step approach involving nutrition risk screening and those fulfilling GLIM consensus were further diagnosed. The evaluation of muscle mass as one constituent contained in the GLIM criteria was conducted by SMI and HGS, respectively. Consistency test, Kaplan-Meier curve, and multivariate Cox regression were used to assess the performance of GLIM-SMI and GLIM-HGS. RESULTS Among 184 hospitalized patients with cirrhosis, 63 (34.2%) and 78 (42.4%) were diagnosed with malnutrition following GLIM-SMI and GLIM-HGS criteria, respectively. Considering the GLIM-SMI a gold standard, GLIM-HGS had a sensitivity of 87.3% and a specificity of 81.0%. GLIM-HGS criteria denoted good agreement (κ value = 0.858, P < 0.001) as compared with GLIM-SMI. Both criteria were independently associated with 1-year all-cause mortality, whereas GLIM-SMI showed slightly higher hazard ratios. Moreover, HGS positively correlated with SMI in the population alongside more pronounced correlation among patients at nutrition risk. CONCLUSION HGS may serve as a substitutive metric of muscle mass contained in the GLIM criteria to diagnose malnutrition and predict long-term mortality among patients with cirrhosis.
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Affiliation(s)
- Gaoyue Guo
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Wanting Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Sipu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Chaoqun Li
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Internal Medicine, Tianjin Hexi Hospital, Tianjin, China
| | - Lihong Mao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
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8
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Zare S, Hasani M, Estêvão MD, Tahmasebi R, Azadbakht L, Shidfar F, Heshmati J, Ziaei S. Muscle Strength and Biochemical Markers as Predictors of Depression in Hemodialysis Patients: A Cross-Sectional Study. Clin Nutr Res 2023; 12:293-303. [PMID: 37969939 PMCID: PMC10641328 DOI: 10.7762/cnr.2023.12.4.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 11/17/2023] Open
Abstract
Patients with chronic renal failure, many of which treated with hemodialysis, present a high prevalence of impaired muscle strength which suggest that muscle mass parameters may be used as markers for changes in muscle in these patients. Measurement of handgrip strength (HGS) is a common, simple, and quick measure of muscle function an indicator of overall muscle strength which has been associated with physical activity and several anthropometric traits. Intercellular adhesion molecule-1 (ICAM-1) and insulin-like growth factor-1 (IGF-1) are biochemical markers associated with inflammatory processes which are a common consequence of dialysis. Additionally, hemodialysis patients frequently present signs of malnutrition and depression. This cross-sectional study aimed to evaluate if muscle and biochemical markers could be used to predict the risk of depression in hemodialysis patients. Several anthropometric parameters, nutrient intake, depression state and the serum levels of ICAM-1 and IGF-1 were determined and Pearson's correlation coefficient and/or Spearman's correlation coefficient were used to test the correlation between them. Our results do not show a correlation between HGF, IGF-1 and ICAM-1 with the depression status of the patients, but mid-arm muscle circumference (MAMC) was statistically and positively correlated with depression. Additionally, ICAM-1 levels were negatively correlated with HGS, MAMC, and IGF-1. Overall, the results of the present study suggest that HGS may be used as an indicator of cardiovascular diseases and MAMC may be a good predictor of the level of depression in hemodialysis patients, although further studies are required.
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Affiliation(s)
- Soudabeh Zare
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Motahareh Hasani
- Department of Nutritional Sciences, School of Health, Golestan University of Medical Sciences, Gorgan 49341-74515, Iran
| | - M. Dulce Estêvão
- Universidade do Algarve, Escola Superior de Saúde, Campus de Gambelas, Faro 8005-139, Portugal
| | - Rahim Tahmasebi
- Department of Epidemiology & Biostatistics, School of Health, Bushehr University of Medical Sciences, Bushehr 7514633341, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran 141556117, Iran
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran
| | - Javad Heshmati
- ICU Department, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah 6714415333, Iran
| | - Somayeh Ziaei
- ICU Department, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah 6714415333, Iran
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9
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Wang H, Wang S, Li C, Yang W, Guo G, Hui Y, Wang X, Cui B, Fan X, Jiao H, Sun C. Coexistent GLIM-Defined Malnutrition and Sarcopenia Increase the Long-Term Mortality Risk in Hospitalized Patients with Decompensated Cirrhosis. ANNALS OF NUTRITION & METABOLISM 2023; 79:423-433. [PMID: 37725950 DOI: 10.1159/000534152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION The synergistic impact of coexistent malnutrition and sarcopenia on morality in hospitalized patients with decompensated cirrhosis remains elusive. This prospective cohort study aimed to delineate the prevalence concerning coexistence of malnutrition and sarcopenia and the prognosticating role on long-term mortality among cirrhosis. METHODS Adult cirrhotic patients with decompensated episodes between 2019 and 2021 were consecutively enrolled. Malnutrition and sarcopenia were diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, respectively. The entire cohort was divided into three groups: non-malnutrition and non-sarcopenia (NN), malnutrition or sarcopenia, and coexistent malnutrition and sarcopenia (MS). Log-rank test and multivariate Cox regression model were utilized to evaluate survival status and independent risk factors for mortality, respectively. RESULTS Our findings indicated that malnutrition manifested in 44.6% of inpatients with decompensated cirrhosis, while sarcopenia presented in 16.4% of the entire cohort, indicative of a prevalence of 14.7% regarding coexistent malnutrition and sarcopenia. The Kaplan-Meier graphic demonstrated a significant difference regarding survival curves among the three groups, referring to the MS group presented with the lowest survival rate (log-rank test: p < 0.001). Moreover, coexistent malnutrition and sarcopenia were associated with nearly 4 times higher mortality risk (model 1: hazard ratio [HR] = 3.31, 95% confidence interval [CI]: 1.20-9.13, p = 0.020; model 2: HR = 4.34, 95% CI: 1.52-12.4, p = 0.006) in comparison with patients without any condition (NN group). CONCLUSIONS Malnutrition and sarcopenia had superimposed negative impacts on inpatients with decompensated cirrhosis. It is imperative to identify this vulnerable subset to provide prompt therapeutic intervention for better prognosis.
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Affiliation(s)
- Han Wang
- Department of Health Management, Tianjin Hospital, Tianjin, China
| | - Sipu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Chaoqun Li
- Department of Internal Medicine, Tianjin Hexi Hospital, Tianjin, China
| | - Wanting Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Gaoyue Guo
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huanli Jiao
- Department of Health Management, Tianjin Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
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10
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Côrtes DM, Boulhosa RSDSB, L da S L Paz C, Cunha CDM, de Oliveira LPM, Lyra AC, Bueno AA, de Jesus RP. Handgrip strength is associated with 12-month survival in male patients suffering with advanced chronic liver disease. J Hum Nutr Diet 2023; 36:1170-1178. [PMID: 36793195 DOI: 10.1111/jhn.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Advanced chronic liver disease (ACLD) patients are usually malnourished, and both conditions in combination increase the likelihood of unfavourable clinical outcomes. Handgrip strength (HGS) has been suggested as a relevant parameter for nutritional assessment and predictor of adverse clinical outcomes in ACLD. However, the HGS cut-off values for ACLD patients have not yet been reliably established. The aims of this study were to preliminarily identify HGS reference values in a sample population of ACLD male patients and to assess their association with survival over a 12-month follow-up period. METHODS This was a prospective observational study with preliminary analysis of outpatients and inpatients. A total of 185 male patients with a medical diagnosis of ACLD met the inclusion criteria and were invited to participate in the study. The physiological variation in muscle strength related to the age of the individuals included in the study was considered to obtain cut-off values. RESULTS After categorising HGS by age group (adults: 18-60 years; elderly: ≥60 years), the reference values obtained were 32.5 kg for the adults and 16.5 kg for the elderly. During the 12-month follow-up, 20.5% of the patients died, and 76.3% of those had been identified with reduced HGS. CONCLUSIONS Patients with adequate HGS showed significantly higher 12-month survival than those with reduced HGS within the same period. Our findings show that HGS is an important predictive parameter for clinical and nutritional follow-up in ACLD male patients.
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Affiliation(s)
- Daniela M Côrtes
- Post Graduate Program, School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ramona S da S B Boulhosa
- Post Graduate Program, School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Carla de M Cunha
- Science Nutrition Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Food, Nutrition and Health Post-Graduation Program, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lucivalda P M de Oliveira
- Science Nutrition Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Food, Nutrition and Health Post-Graduation Program, Federal University of Bahia, Salvador, Bahia, Brazil
| | - André C Lyra
- Department of Gastroenterology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Allain A Bueno
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester, UK
| | - Rosângela P de Jesus
- Science Nutrition Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Food, Nutrition and Health Post-Graduation Program, Federal University of Bahia, Salvador, Bahia, Brazil
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11
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Cui B, Hui Y, Sun C. Relationship between lipid profiles and reduced handgrip strength (dynapenia) in hospitalized patients with cirrhosis. Eur J Gastroenterol Hepatol 2023; 35:575-582. [PMID: 36966759 DOI: 10.1097/meg.0000000000002536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Dynapenia embraces clinical significance and predictive value separated from skeletal muscle loss among cirrhosis. Moreover, alterations in lipid levels may impact muscle function. It has yet to elucidate the relationship between lipid profiles and muscle strength weakness. We sought to explore which lipid metabolism indicator could be useful to identify patients with dynapenia in daily practice. METHODS A retrospective observational cohort study enrolling 262 cirrhotic patients. Analysis of the receiver operating characteristic (ROC) curve was performed to determine the discriminatory cutoff for dynapenia. Multivariate logistic regression was conducted to assess the association between total cholesterol (TC) and dynapenia. Also, we established a model based on the classification and regression tree method. RESULTS ROC implicated a cutoff of TC ≤ 3.37 mmol/L to identify dynapenia. Patients with TC ≤ 3.37 mmol/L showed significantly lower handgrip strength (HGS; 20.0 vs. 24.7 kg, P = 0.003), lower hemoglobin, lower platelet, lower white blood cell count, lower sodium and higher prothrombin-international normalized ratio. A positive correlation was found between TC and HGS values ( r = 0.1860, P = 0.003). TC remained a significant association with dynapenia after controlling for variables including age, sex, BMI, and the presence of ascites. The decision tree incorporating TC, BMI, and age had a sensitivity of 71.4%, specificity of 64.9%, and an area under ROC of 0.681. CONCLUSION TC ≤ 3.37 mmol/L was significantly associated with the presence of dynapenia. Assessing TC may be helpful for identifying dynapenic patients with cirrhosis in the health care or hospital setting.
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Affiliation(s)
- Binxin Cui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
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12
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Annual changes in grip strength and skeletal muscle mass in chronic liver disease: observational study. Sci Rep 2023; 13:1648. [PMID: 36717617 PMCID: PMC9887068 DOI: 10.1038/s41598-023-28528-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Sarcopenia is a common complication in patients with chronic liver disease (CLD); however, the progression of sarcopenia over the course of CLD is unclear. The present study therefore determined the natural course of the progression of sarcopenia in patients with CLD and the effect of liver cirrhosis (LC) on this progression. This observational study analyzed patients with chronic hepatitis (CH) (n = 536) and LC (n = 320) who underwent evaluations of the grip strength and skeletal muscle mass of the arms, trunk, and legs for sarcopenia between 2016 and 2021. A bioelectrical impedance analysis was used to evaluate skeletal muscle mass. The annual rate of change (%/year) in two tests were compared between patients with CH and LC. The annual rates of change in grip strength and skeletal muscle of arms, trunk, and legs of patients with CH and LC were - 0.84% vs. - 2.93%, - 0.54% vs. - 1.71%, - 0.43% vs. - 1.02%, and - 0.76% vs. - 1.70% for men and - 0.12% vs. - 1.71%, - 0.66% vs. - 1.71%, - 0.49% vs. - 1.31%, and - 0.76% vs. - 1.54% for women, respectively. The progression of sarcopenia was greater in LC patients than in CH patients and that the decrease in grip strength was most prominent in the progression of sarcopenia in patients with LC.
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13
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Lowe R, Hey P, Sinclair M. The sex-specific prognostic utility of sarcopenia in cirrhosis. J Cachexia Sarcopenia Muscle 2022; 13:2608-2615. [PMID: 35945660 PMCID: PMC9745556 DOI: 10.1002/jcsm.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 06/07/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
Sarcopenia is an increasingly recognized complication of cirrhosis that is associated with morbidity and mortality. Differences in the prevalence and prognosis of sarcopenia between men and women have been reported in other patient groups, but there is insufficient understanding of how sex impacts the prognostic value of sarcopenia in cirrhosis. A search of MEDLINE and Embase was conducted from earliest entries to April 2021. Studies were included if they examined sex-stratified mortality impact of reduced muscle function or mass in outpatient populations with cirrhosis. We identified 700 studies of which 6 were deemed relevant for inclusion in this narrative review. Studies of interest were heterogeneous, precluding pooling of data and making interpretation of the literature challenging. Muscle mass was assessed in five studies (n = 2566, 1730 men, 836 women) and was reduced in 36-50% of men and 24-43% of women. All five studies found that reduced muscle mass determined by computed tomography, dual-energy X-ray absorptiometry, and bioelectrical impedance analysis was associated with increased mortality in men. Of these, two studies identified a corresponding relationship in women; reduced muscle mass defined by computed tomography was associated with increased mortality [hazard ratio (HR) 2.82, P = 0.001], while increasing muscle mass by bioelectrical impedance analysis likewise conferred a survival benefit (HR 0.45, P = 0.0016). Only one study assessed the relationship of muscle function with sex-stratified mortality (n = 1405, 827 men, 578 women), concluding that reduced muscle function predicted mortality in both men and women (HR 1.65, P < 0.001 and HR 1.54, P < 0.001, respectively). Reduced muscle mass in cirrhosis is consistently associated with mortality in men, but lack of sex-stratification of mortality analyses limits the ability to make strong conclusions about the impact of sarcopenia specifically in women, with even fewer data available for analysing muscle function. Improved understanding of the sex-specific impacts of sarcopenia may help address patient deterioration and mortality while awaiting liver transplantation and allow for early intervention to mitigate mortality risk. Large, multicentre studies with adequate female participation and sex-stratified mortality analyses are warranted.
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Affiliation(s)
- Ryan Lowe
- University of Melbourne, Melbourne, Victoria, Australia.,Northern Health, Epping, Victoria, Australia
| | - Penelope Hey
- University of Melbourne, Melbourne, Victoria, Australia.,Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
| | - Marie Sinclair
- University of Melbourne, Melbourne, Victoria, Australia.,Liver Transplant Unit, Austin Health, Heidelberg, Victoria, Australia
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14
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Sugiyama Y, Ishizu Y, Ando Y, Yokoyama S, Yamamoto K, Ito T, Imai N, Nakamura M, Honda T, Kawashima H, Ishikawa T, Ishigami M. An improved method to assess skeletal muscle mass in patients with liver cirrhosis based on computed tomography images. Hepatol Res 2022; 52:937-946. [PMID: 35921254 DOI: 10.1111/hepr.13820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/26/2022] [Accepted: 07/17/2022] [Indexed: 02/08/2023]
Abstract
AIM Conventionally, the skeletal muscle area with computed tomography (CT) attenuation ranging from -29 to +150 Hounsfield unit (HU) divided by height squared (the conventional skeletal muscle index [SMI]) was used as an index of skeletal muscle mass. However, it includes fat-infiltrated skeletal muscle, which is known to have poor function. This study aims to determine whether the low-fat SMI, which uses skeletal muscle mass with CT attenuation ranging from +30 to +150 HU, or conventional SMI appropriately reflects the function of skeletal muscle. METHODS We retrospectively analyzed 120 patients with cirrhosis whose handgrip strength was measured. Among them, 48 patients underwent a physical performance assessment such as liver frailty index (LFI) and short physical performance battery (SPPB), and 80 underwent quality of life (QOL) assessment. The relationships between each SMI and handgrip strength, LFI, SPPB, and QOL were evaluated. RESULTS Low-fat SMI was significantly correlated with handgrip strength (males, R = 0.393, p = 0.002; females, R = 0.423, p < 0.001) and LFI (males, R = -0.535, p = 0.035; females, R = -0.368, p = 0.039), whereas conventional SMI was not. When using low-fat SMI, patients with low skeletal muscle mass had significantly low handgrip strength, LFI, SPPB, and physical and social-related QOL score than those without. By contrast, no significant differences were found for any items when using conventional SMI. CONCLUSIONS Low-fat SMI is a good index of skeletal muscle mass that appropriately reflects skeletal muscle function.
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Affiliation(s)
- Yoshiaki Sugiyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Ando
- Department of Gastroenterology, Handa City Hospital, Handa, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Ishikawa
- Department of Radiological and Medical Laboratory Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Xiong J, Tian Y. Evaluating sarcopenia in patients with cirrhosis: The role of muscle function. J Hepatol 2022; 77:564-565. [PMID: 35351521 DOI: 10.1016/j.jhep.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Jianping Xiong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yantao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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16
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Tajiri K, Futsukaichi YH, Murayama A, Minemura M, Takahara T, Yasuda I. Chronic liver disease questionnaire to manage patients with chronic liver diseases. Hepatol Res 2022; 52:712-720. [PMID: 35505586 DOI: 10.1111/hepr.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/13/2022] [Accepted: 04/27/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Although patients with chronic liver disease (CLD) usually show few symptoms, they exhibit decreased health-related QOL (HRQOL) with occurrence complications including hepatocellular carcinoma (HCC). Health-related QOL is an important indicator in the management of CLD. The Chronic Liver Disease Questionnaire (CLDQ) was established as a tool for assessment of HRQOL. In this study, we evaluate its usefulness for the management of daily clinical practice. METHODS Patients (N = 190, median age 70 years old) treated between 2016 and 2019 were registered and prospectively followed-up with annual CLDQ. Associations of liver function and development of factors for admission or death were evaluated. RESULTS Of the 190 patients registered, median age 70 years old, 140 were Child-A, 121 were Fib-4 index >2.67 and showed 80 HCC. All 6 domains including Systemic Symptoms (SS) were negatively correlated with Child-Pugh score more than with albumin-bilirubin score and Fib-4 index. A hundred four admission events and 49 deaths were found during observation period, and median event-free survival was 34.3 months. Treatment for HCC was the most frequent cause of admission, and 37 liver-related deaths were found. Systemic Symptoms score 2 years after registration was decreased in both HCC- and non-HCC cohort. Systemic Symptoms decreased and SS < 4 might be predictive for event occurrence. CONCLUSIONS CLDQ is useful to assess HRQOL in patients with CLD and is well correlated with liver function especially Child-Pugh. Chronic Liver Disease Questionnaire might be useful to predict the prognosis of CLD and can be a tool of management in clinical practice.
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Affiliation(s)
- Kazuto Tajiri
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | | | - Aiko Murayama
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Masami Minemura
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Terumi Takahara
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
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17
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Chapman B, Goh SK, Parker F, Romero S, Sinclair M, Gow P, Ma R, Angus P, Jones R, Luke J, Muralidharan V, Testro A. Malnutrition and low muscle strength are independent predictors of clinical outcomes and healthcare costs after liver transplant. Clin Nutr ESPEN 2022; 48:210-219. [PMID: 35331494 DOI: 10.1016/j.clnesp.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Malnutrition and sarcopenia are associated with increased morbidity and mortality in cirrhosis but conflicting data are reported after liver transplantation (LT), with little known about the economic burden of malnutrition at LT. This study aims to investigate the impact of pre-transplant malnutrition and muscle strength on post-transplant clinical outcomes and healthcare costs. METHODS Pre-transplant nutritional status (via subjective global assessment, SGA) and handgrip strength (HGS) were assessed in patients transplanted from 2009-2017. Descriptive statistics and regression analysis were used to analyse the association between nutrition and muscle function with post-LT clinical outcomes and hospital costs. RESULTS 373 patients (70% male, median age 55 [IQR: 47, 60]) were transplanted, with 79% malnourished and mean HGS 31.4 ± 9.35 kg for males and 17.6 ± 5.78 kg for females. Malnutrition and reduced HGS independently predicted adverse post-transplant outcomes. ICU length of stay (LOS) was associated with severe malnutrition (HR (time to discharge (TTD)) 0.706, p = 0.014) and low HGS (HR (TTD) 0.692, p = 0.003); hospital LOS with severe malnutrition (HR (TTD) 0.759, p = 0.049) and low HGS (HR (TTD) 0.730, p = 0.011), and post-transplant infection with severe malnutrition (OR 1.76, p = 0.042) and low HGS (OR 1.83, p = 0.015). Accordingly, hospital costs were 30% higher in severely malnourished compared to well-nourished recipients (p = 0.012). Neither malnutrition or impaired HGS were associated with post-transplant mortality. CONCLUSIONS This large cohort study demonstrates malnutrition and muscle weakness are independently associated with early post-transplant morbidity, namely infection and ICU and hospital LOS; with significantly increased hospital costs. Strategies to combat malnutrition and deconditioning pre-transplant may improve patient and health system outcomes after LT.
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Affiliation(s)
- Brooke Chapman
- Nutrition and Dietetics Department, Austin Health, Melbourne, Australia; The University of Melbourne, Melbourne, Australia.
| | - Su Kah Goh
- The University of Melbourne, Melbourne, Australia; Liver Transplant Unit, Austin Health, Melbourne, Australia.
| | - Frank Parker
- The University of Melbourne, Melbourne, Australia.
| | - Sarah Romero
- Liver Transplant Unit, Austin Health, Melbourne, Australia.
| | - Marie Sinclair
- The University of Melbourne, Melbourne, Australia; Liver Transplant Unit, Austin Health, Melbourne, Australia.
| | - Paul Gow
- The University of Melbourne, Melbourne, Australia; Liver Transplant Unit, Austin Health, Melbourne, Australia.
| | - Ronald Ma
- The University of Melbourne, Melbourne, Australia.
| | - Peter Angus
- The University of Melbourne, Melbourne, Australia; Liver Transplant Unit, Austin Health, Melbourne, Australia.
| | - Robert Jones
- The University of Melbourne, Melbourne, Australia; Liver Transplant Unit, Austin Health, Melbourne, Australia.
| | - Jacqueline Luke
- Physiotherapy Department, Austin Health, Melbourne, Australia.
| | - Vijayaragavan Muralidharan
- The University of Melbourne, Melbourne, Australia; Liver Transplant Unit, Austin Health, Melbourne, Australia.
| | - Adam Testro
- The University of Melbourne, Melbourne, Australia; Liver Transplant Unit, Austin Health, Melbourne, Australia.
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18
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Murata K, Namisaki T, Fujimoto Y, Takeda S, Enomoto M, Takaya H, Tsuji Y, Shibamoto A, Suzuki J, Kubo T, Iwai S, Tomooka F, Tanaka M, Kaneko M, Asada S, Koizumi A, Yorioka N, Matsuda T, Ozutsumi T, Ishida K, Ogawa H, Takagi H, Fujinaga Y, Furukawa M, Sawada Y, Nishimura N, Kitagawa K, Sato S, Kaji K, Inoue T, Asada K, Kawaratani H, Moriya K, Akahane T, Mitoro A, Yoshiji H. Clinical Significance of Serum Zinc Levels on the Development of Sarcopenia in Cirrhotic Patients. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:184-193. [PMID: 35399181 PMCID: PMC8962814 DOI: 10.21873/cdp.10093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM Sarcopenia increases the mortality in patients with cirrhosis. Approximately 60% of zinc is accumulated in skeletal muscle. We aimed to determine the role of subclinical zinc deficiency on sarcopenia development in patients with cirrhosis. PATIENTS AND METHODS We enrolled 151 patients with cirrhosis and divided them into the group with normal serum zinc levels (Group N: 80-130 μg/dl; n=38) and group with subclinical zinc deficiency (Group D: <80 μg/dl; n=113). The risk factors for sarcopenia were then investigated. RESULTS Group D had more sarcopenia cases than Group N (31.0% vs. 13.2%). In group D, HGS exhibited a weakly positive but significant correlation with serum zinc levels (R=0.287, p=0.00212), serum zinc levels negatively correlated with both ammonia and myostatin levels (R=-0.254, p=0.0078; R=-0.33, p<0.01), and low zinc levels were independently associated with sarcopenia development. CONCLUSION Patients with cirrhosis showing subclinical zinc deficiency have a significantly higher risk of developing sarcopenia.
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Affiliation(s)
- Koji Murata
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yuki Fujimoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Soichi Takeda
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Masahide Enomoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yuki Tsuji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Akihiko Shibamoto
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Junya Suzuki
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takahiro Kubo
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Satoshi Iwai
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Fumimasa Tomooka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Misako Tanaka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Miki Kaneko
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Shohei Asada
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Aritoshi Koizumi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Nobuyuki Yorioka
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takuya Matsuda
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takahiro Ozutsumi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Koji Ishida
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hiroyuki Ogawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hirotetsu Takagi
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Masanori Furukawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Yasuhiko Sawada
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Koh Kitagawa
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Shinya Sato
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takashi Inoue
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Kiyoshi Asada
- Institute for Clinical and Translational Science, Nara Medical University Hospital, Kashihara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Kei Moriya
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Takemi Akahane
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Akira Mitoro
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology of Nara Medical University, Kashihara, Japan
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Obesity and myosteatosis: the two characteristics of dynapenia in patients with cirrhosis. Eur J Gastroenterol Hepatol 2021; 33:e916-e921. [PMID: 35048658 DOI: 10.1097/meg.0000000000002303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE In patients with liver cirrhosis, the clinical characteristics of dynapenia, a condition in which skeletal muscle mass is maintained but muscle strength is reduced, are not yet known. This study aimed to clarify the characteristics of dynapenia and its impact on quality of life (QOL) in patients with liver cirrhosis. METHODS We retrospectively analyzed 116 patients with cirrhosis. Based on grip strength and skeletal muscle mass measured by the bioelectrical impedance analysis method, patients were divided into four groups: normal muscle status, dynapenia, pre-sarcopenia (a condition involving only low muscle mass), and sarcopenia. The characteristics of dynapenia and its influence on QOL were examined. RESULTS Fourteen patients had dynapenia. Liver function did not differ among the four groups. In patients with dynapenia, BMI was highest and computed tomography attenuation of skeletal muscle at the third lumbar spine vertebra was lowest among the four groups. The percentage of patients with both BMI ≥25 kg/m2 and myosteatosis was significantly higher in patients with dynapenia [9/14 (64.3%)] than in those with sarcopenia [2/23 (8.7%), P = 0.004] and pre-sarcopenia [0/18 (0%), P < 0.001] and tended to be higher than those with normal muscle status [16/61 (26.2%), P = 0.065]. The physical QOL in patients with dynapenia was as low as that in those with sarcopenia and significantly lower than that in those with normal muscle status. CONCLUSION Cirrhotic patients with dynapenia had high BMI and myosteatosis, and impaired physical QOL.
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20
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West J, Gow PJ, Testro A, Chapman B, Sinclair M. Exercise physiology in cirrhosis and the potential benefits of exercise interventions: A review. J Gastroenterol Hepatol 2021; 36:2687-2705. [PMID: 33638197 DOI: 10.1111/jgh.15474] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/19/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
Reduction in muscle mass is a highly prevalent phenomenon in cirrhosis and is now well-documented to be associated with significant morbidity and mortality. Research into muscle loss in cirrhosis remains limited by an ongoing poor understanding of its relationship with muscle function, physical activity, and aerobic capacity. Alterations in exercise physiology have been documented in studies of individuals with cirrhosis that provide important information on physical function that is not captured by simple quantification of muscle mass. Despite expert consensus recommending regular exercise in end-stage liver disease to maintain muscle mass and function, there is little evidence guiding clinicians as to which form of exercise or delivery mechanism is most effective. It also remains unproven whether any specific intervention can alter clinically relevant outcomes. This review article summarizes the available literature regarding the changes in exercise physiology observed in cirrhosis, the associated impact on physical capacity, and the results of existing trials that examine the potential benefits of exercise delivery in patients with cirrhosis, particularly pertaining to their impact on exercise physiology.
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Affiliation(s)
- Jack West
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul J Gow
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Brooke Chapman
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Marie Sinclair
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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21
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Nishikawa H, Shiraki M, Hiramatsu A, Hara N, Moriya K, Hino K, Koike K. Reduced handgrip strength predicts poorer survival in chronic liver diseases: A large multicenter study in Japan. Hepatol Res 2021; 51:957-967. [PMID: 34057800 DOI: 10.1111/hepr.13679] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
AIM Sarcopenia has a high prevalence and can be an adverse predictor in patients with chronic liver diseases (CLDs). We sought to assess the prevalence of sarcopenia and its prognostic significance in patients with CLDs at multiple centers in Japan. METHODS In this retrospective study, we collated the data of 1624 patients with CLDs (976 men). The diagnosis of sarcopenia was determined by the sarcopenia assessment criteria of the Japan Society of Hepatology. Predictors of mortality were identified using univariate and multivariate analyses. RESULTS Muscle weakness and skeletal muscle loss occurred in 33.5% and 29.3% of all subjects, respectively, while sarcopenia occurred in 13.9% of all patients. Patients with sarcopenia had a poorer prognosis among all patients, patients with hepatocellular carcinoma (HCC), and those without HCC by log-rank test. The multivariate Cox proportional hazards model identified female gender (hazard ratio [HR], 0.59; p = 0.03), alcoholic liver disease (HR, 4.25; p < 0.01), presence of HCC (HR, 6.77; p < 0.01), Child-Pugh classes A (HR, 1.42; p < 0.05), B (HR, 2.70; p < 0.01), and C (HR, 6.30; p < 0.01), and muscle weakness (HR, 2.24; p < 0.01) as significant adverse predictors. The cut-off values of handgrip strength (HGS) for prognosis determined by maximally selected rank statistics were calculated as 27.8 kg for men and 18.8 kg for women. CONCLUSION Reduced HGS in patients with CLD was an independent adverse predictor of mortality, with cut-off values of 27.8 kg for men and 18.8 kg for women.
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Affiliation(s)
- Hiroki Nishikawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Japan
| | - Makoto Shiraki
- Department of Gastroenterology and Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akira Hiramatsu
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Nagisa Hara
- Nutrition Unit, Mie University Hospital, Tsu, Japan
| | - Kyoji Moriya
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keisuke Hino
- Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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22
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Siqueira MRD, Pace FHDL, Limongi TM, Henrique DMN, Mira PADC, Oliveira TMDD, Oliveira CC, Aguiar ASD, Malaguti C. Factors associated with the perceived benefits and barriers to physical activity in liver cirrhosis. ACTA ACUST UNITED AC 2021; 67:271-276. [PMID: 34406252 DOI: 10.1590/1806-9282.67.02.20200692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the sociodemographic and clinical factors associated with the perceived benefits and barriers to physical activity (PA) in subjects with liver cirrhosis. METHODS This cross-sectional study assessed 102 outpatients with liver cirrhosis regarding the clinical and sociodemographic profile and the perceived benefits and barriers to PA by the Exercise Benefits and Barriers Scale and muscle strength. A Generalized Step-Forward linear regression analysis was used to identify the factors associated. RESULTS The participants were 59±10 years and 60.8% were men. Around 29.4% had ascites decompensation. Perceived benefits and barriers were associated with the presence of ascites (95%CI -0.079 - 0.03; p=0.06 and 95%CI 0.003 - 0.217; p=0.045, respectively). In the group with ascites, both benefits and barriers were associated with muscle strength. In the group without ascites, benefits were associated with cardiovascular risks and no association was observed with barriers to physical activity. CONCLUSIONS Perceived benefits and barriers to physical activity are associated with intrinsic factors such as the presence of ascites and cardiovascular risk in individuals with liver cirrhosis. The results of this study highlight key elements that must be considered for increasing physical activity in this population.
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Affiliation(s)
| | | | - Tuany Mageste Limongi
- Universidade Federal de Juiz de Fora, Program in Physical Education - Juiz de Fora (MG), Brazil
| | | | - Pedro Augusto de Carvalho Mira
- Universidade Federal de Juiz de Fora, Program in Physical Education - Juiz de Fora (MG), Brazil.,Universidade Federal Fluminense, Department of Physiology and Pharmacology - Niteroi (RJ), Brazil
| | - Túlio Medina Dutra de Oliveira
- Universidade Federal de Juiz de Fora, Program on Rehabilitation Sciences and Physical Function Performance - Juiz de fora (MG), Brazil
| | - Cristino Carneiro Oliveira
- Universidade Federal de Juiz de Fora, Program on Rehabilitation Sciences and Physical Function Performance - Juiz de fora (MG), Brazil
| | - Aline Silva de Aguiar
- Universidade Federal de Juiz de Fora, Program in Public Health - Juiz de Fora (MG), Brazil
| | - Carla Malaguti
- Universidade Federal de Juiz de Fora, Program on Rehabilitation Sciences and Physical Function Performance - Juiz de fora (MG), Brazil
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Hanai T, Hiraoka A, Shiraki M, Sugimoto R, Taniki N, Hiramatsu A, Nakamoto N, Iwasa M, Chayama K, Shimizu M. Utility of the SARC-F Questionnaire for Sarcopenia Screening in Patients with Chronic Liver Disease: A Multicenter Cross-Sectional Study in Japan. J Clin Med 2021; 10:3448. [PMID: 34362231 PMCID: PMC8348368 DOI: 10.3390/jcm10153448] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 12/23/2022] Open
Abstract
Diagnosing sarcopenia is challenging. This multicenter cross-sectional study aimed to evaluate the utility of the SARC-F score system for identifying sarcopenia in patients with chronic liver disease (CLD). We enrolled 717 patients from five participating centers who completed the SARC-F between November 2019 and March 2021. Sarcopenia was diagnosed based on the Japan Society of Hepatology Working Group on Sarcopenia in Liver Disease Consensus. Muscle strength was estimated using a grip dynamometer, and muscle mass was assessed using computed tomography or bioelectrical impedance analysis. The association between SARC-F and sarcopenia was analyzed using a logistic regression model. The optimal SARC-F cutoff value for identifying sarcopenia was determined using receiver operating characteristic (ROC) curve analysis. Of the 676 eligible patients, 15% were diagnosed with sarcopenia. The SARC-F distribution was 0 points in 63% of patients, 1 point in 17%, 2 points in 7%, 3 points in 4%, and ≥4 points in 8%. The SARC-F items of "Strength" (odds ratio (OR), 1.98; 95% confidence interval (CI), 1.03-3.80) and "Falls" (OR, 2.44; 95% CI, 1.48-4.03) were significantly associated with sarcopenia. The SARC-F value of 1 point showed a higher discriminative ability for identifying sarcopenia than the 4 points that are conventionally used (p < 0.001), with an area under the ROC curve of 0.68, sensitivity of 0.65, specificity of 0.68, positive predictive value of 0.27, and negative predictive value of 0.92. SARC-F is useful for identifying patients with CLD who are at risk of sarcopenia.
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Affiliation(s)
- Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (M.S.); (M.S.)
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama 790-0024, Japan;
| | - Makoto Shiraki
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (M.S.); (M.S.)
| | - Ryosuke Sugimoto
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (R.S.); (M.I.)
| | - Nobuhito Taniki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.T.); (N.N.)
| | - Akira Hiramatsu
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima 734-8553, Japan;
| | - Nobuhiro Nakamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; (N.T.); (N.N.)
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (R.S.); (M.I.)
| | - Kazuaki Chayama
- Collaborative Research Laboratory of Medical Innovation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan;
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; (M.S.); (M.S.)
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24
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Miwa T, Hanai T, Nishimura K, Maeda T, Ogiso Y, Imai K, Suetsugu A, Takai K, Shiraki M, Shimizu M. Handgrip strength stratifies the risk of covert and overt hepatic encephalopathy in patients with cirrhosis. JPEN J Parenter Enteral Nutr 2021; 46:858-866. [PMID: 34287991 DOI: 10.1002/jpen.2222] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Handgrip strength (HGS) is a simple and convenient method to assess nutrition status in patients with cirrhosis. This retrospective study aimed to investigate the utility of HGS for predicting patients with covert hepatic encephalopathy (CHE) and patients at high risk of overt hepatic encephalopathy (OHE). METHODS We reviewed 963 patients with cirrhosis and consequently enrolled eligible 270 patients. HGS was measured using a digital grip dynamometer. CHE was diagnosed using a computer-aided neuropsychiatric test. Factors associated with CHE were estimated using the logistic regression model. Predictors associated with OHE occurrence were analyzed using the Fine-Gray competing risk regression model. RESULTS Of the 270 eligible patients, reduced HGS was observed in 102 (38%), reduced muscle mass in 107 (40%), and CHE in 53 (20%). Multivariate analysis showed that serum ammonia levels (odds ratio [OR], 2.23; 95% CI, 1.14-4.36; P = 0.014) and reduced HGS (OR, 3.68; 95% CI, 1.93-7.03; P < 0.001) were independently associated with CHE. During the median follow-up period of 24.5 months, 43 (16%) patients experienced OHE. After adjusting for possible confounding factors, multivariate analysis showed that reduced HGS (subdistribution hazard ratio, 2.36; 95% CI, 1.27-4.38; P = 0.007) was a significant predictor in the development of OHE. CONCLUSION Patients with reduced HGS had a higher prevalence of CHE and a higher risk for OHE occurrence than those with normal HGS. The measurement of HGS could be a simple bedside modality to stratify the patients' risk for CHE and OHE.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.,Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Kayoko Nishimura
- Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan
| | - Toshihide Maeda
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yui Ogiso
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.,Division for Regional Cancer Control, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Makoto Shiraki
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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25
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Nishikawa H, Yoh K, Enomoto H, Nishimura T, Nishiguchi S, Iijima H. Factors Associated With Longitudinal QOL Change in Patients With Chronic Liver Diseases. In Vivo 2021; 35:2451-2456. [PMID: 34182530 DOI: 10.21873/invivo.12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022]
Abstract
AIM To examine the relationship between longitudinal quality of life (QOL) change, as assessed by the 36-Item Short Form Health Survey (SF-36), sarcopenia-related factors and body composition in patients with chronic liver diseases (CLDs). PATIENTS AND METHODS Data from patients with CLDs (n=184) were retrospectively analyzed, focusing on factors associated with the difference of physical and mental component summary score (PCS and MCS) in SF-36 between the two visits (ΔPCS and ΔMCS). The difference of serum albumin level, body mass index (BMI), arm circumference, arm muscle circumference, grip strength (GS), skeletal muscle index, extracellular to total body water ratio between the two visits were included into the multiple regression analysis. RESULTS Δalbumin (p=0.0325) and ΔGS (p<0.0001) were independent factors linked to ΔPCS Δalbumin (p=0.0005) and ΔBMI (p=0.0232) were independent factors linked to ΔMCS Conclusion: Significance of serum albumin level, muscle strength and body composition on health-related QOL in CLD patients should be emphasized.
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Affiliation(s)
- Hiroki Nishikawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan; .,Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazunori Yoh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirayuki Enomoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Nishimura
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Hiroko Iijima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
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26
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Nishikawa H, Yoh K, Enomoto H, Ikeda N, Takashima T, Aizawa N, Nishimura T, Nishiguchi S, Iijima H. Predictors for Grip Strength Loss in Patients With Chronic Liver Diseases. In Vivo 2021; 35:363-371. [PMID: 33402485 DOI: 10.21873/invivo.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To elucidate factors associated with secular changes of grip strength (GS) in patients with chronic liver diseases (CLDs) (n=241, 102 males, median age=63 years, 87 liver cirrhosis cases). MATERIALS AND METHODS ΔGS (kg/year) was defined as [GS value (second time) - GS value (first time)]/[time interval between the first and second time]. GS loss (GSL) was defined as ΔGS <0 kg/year. RESULTS The median ΔGS in patients with non-LC, Child-Pugh A (n=70) and Child-Pugh B (n=17) were 0.3, -0.2 and -1.6 kg/year (overall p<0.0001). In the multivariate analysis of factors linked to the GSL for all cases, extracellular water (ECW) to total body water (TBW) ratio was significant (p=0.0007). In the multivariate analysis in male, no significant factor was found, while in female, ECW to TBW ratio was significant (p=0.0024). CONCLUSION Liver functional parameters can be closely linked to the GSL especially in female CLD patients.
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Affiliation(s)
- Hiroki Nishikawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan; .,Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazunori Yoh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirayuki Enomoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naoto Ikeda
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoyuki Takashima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuhiro Aizawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Nishimura
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Hiroko Iijima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
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27
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Nishikawa H, Yoh K, Enomoto H, Iwata Y, Sakai Y, Kishino K, Shimono Y, Ikeda N, Takashima T, Aizawa N, Takata R, Hasegawa K, Koriyama T, Yuri Y, Nishimura T, Nishiguchi S, Iijima H. Calf Circumference as a Useful Predictor of Sarcopenia in Patients With Liver Diseases. In Vivo 2021; 34:2561-2569. [PMID: 32871785 DOI: 10.21873/invivo.12073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM To elucidate the influence of calf circumference (CC) on sarcopenia in patients with chronic liver damages (CLDs, n=525, 255 men). PATIENTS AND METHODS Anthropometry parameters including arm circumference, arm muscle circumference, CC, arm muscle area, triceps skinfold thickness, waist circumference and body mass index were measured. Patients with both grip strength (GS) decline and skeletal muscle index (SMI) decline were diagnosed as sarcopenic. RESULTS Liver cirrhosis was identified in 103 cases (40.4%) in males and 87 cases (32.2%) in females. Sarcopenia was identified in 23 male patients (9.0%) and 38 female patients (14.1%). CC had the strong positive correlation with SMI both in male (r=0.79, p<0.0001) and female (r=0.83, p<0.0001). Among the above mentioned 7 anthropometry parameters, CC had the highest area under the receiver operating characteristics curve (AUC) for sarcopenia both in males (AUC=0.88) and females (AUC=0.86). CONCLUSION CC can be helpful for predicting sarcopenia in CLDs.
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Affiliation(s)
- Hiroki Nishikawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan .,Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazunori Yoh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirayuki Enomoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshinori Iwata
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshiyuki Sakai
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyohei Kishino
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshihiro Shimono
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naoto Ikeda
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoyuki Takashima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuhiro Aizawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryo Takata
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kunihiro Hasegawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Koriyama
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukihisa Yuri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takashi Nishimura
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Hiroko Iijima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan
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Hiraoka A, Kato M, Marui K, Murakami T, Onishi K, Adachi T, Matsuoka J, Ueki H, Yoshino T, Tsuruta M, Aibiki T, Okudaira T, Kuroda T, Iwasaki R, Suga Y, Miyata H, Ninomiya T, Hirooka M, Abe M, Matsuura B, Michitaka K, Hiasa Y. Easy clinical predictor for low BCAA to tyrosine ratio in chronic liver disease patients with hepatocellular carcinoma: Usefulness of ALBI score as nutritional prognostic marker. Cancer Med 2021; 10:3584-3592. [PMID: 33960691 PMCID: PMC8178498 DOI: 10.1002/cam4.3908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIM Low branched-chain amino acid (BCAA) to tyrosine ratio (BTR) is known as an indicator of amino acid imbalance. We elucidated usefulness of newly developed albumin-bilirubin (ALBI) score as alternative methods of BTR in patients with naïve hepatocellular carcinoma (HCC) retrospectively. MATERIALS/METHODS In 842 patients with HCC and without BCAA supplementation (71 years, male 614, Child-Pugh A:B:C = 689:116:37), relationships among BTR and clinical features were evaluated. Of those, 438 patients, with Milan criteria HCC, treated curatively were divided into the high-BTR (>4.4) (n = 293) and low-BTR (≤4.4) (n = 145) groups. The prognostic value of BTR was evaluated using inverse probability weighting (IPW) with propensity score. RESULTS The low-BTR group showed worse prognosis than the other (3-, 5-, 10-year overall survival rates: 88.9% vs. 86.3%/70.5% vs. 78.1%/38.1% vs. 52.3%, respectively; p < 0.001). Multivariate Cox-hazard analysis adjusted for IPW showed elderly (≥65 years) HR 2.314, p = 0.001), female gender (HR 0.422, p < 0.001), ECOG PS ≥2 (HR 3.032, p = 0.002), low platelet count (HR 1.757, p = 0.010), and low BTR (≤4.4) (HR 1.852, p = 0.005) to be significant prognostic factors. Both serum albumin level (r = 0.370, p < 0.001) and ALBI score (r = -0.389, p < 0.001) showed a significant relationship with BTR. Child-Pugh class B, modified ALBI grade (mALBI) 2a, and mALBI 2b predictive values for BTR were 3.589, 4.509, and 4.155 (AUC range: 0.735-0.770), respectively, while the predictive value of ALBI score for low-BTR (≤4.4) was -2.588 (AUC 0.790). CONCLUSION ALBI score -2.588 was a predictor for low-BTR (≤4.4), which was prognostic factors for early HCC patients, and at least patients with mALBI 2b might have an amino acid imbalance.
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Affiliation(s)
- Atsushi Hiraoka
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Masaya Kato
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Kaori Marui
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Taisei Murakami
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Kei Onishi
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Tomoko Adachi
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Junko Matsuoka
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Hidetaro Ueki
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Takeaki Yoshino
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Miho Tsuruta
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Toshihiko Aibiki
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Tomonari Okudaira
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Taira Kuroda
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Ryuichiro Iwasaki
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Yoshifumi Suga
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Hideki Miyata
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Tomoyuki Ninomiya
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Masashi Hirooka
- Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineEhimeJapan
| | - Masanori Abe
- Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineEhimeJapan
| | - Bunzo Matsuura
- Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineEhimeJapan
| | - Kojiro Michitaka
- Gastroenterology CenterEhime Prefectural Central HospitalMatsuyamaJapan
| | - Yoichi Hiasa
- Department of Gastroenterology and MetabologyEhime University Graduate School of MedicineEhimeJapan
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Nishikawa H, Yoh K, Enomoto H, Nishimura T, Nishiguchi S, Iijima H. Clinical impact of the finger-circle test in patients with liver diseases. Hepatol Res 2021; 51:603-613. [PMID: 33772972 DOI: 10.1111/hepr.13639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
AIM To elucidate the relationship between the finger-circle test (Yubi-wakka [in Japanese] test; three levels of bigger, just-fits, and smaller) and sarcopenia-related factors and anthropometric parameters in patients with chronic liver disease (n = 202, 99 men, mean age 61 years). METHODS Patients with both grip strength decline (<26 kg for men and <18 kg for women) and skeletal muscle index (SMI) decline (<7.0 kg/m2 in men and <5.7 kg/m2 in female) were diagnosed as sarcopenia. RESULTS Liver cirrhosis was found in 56 patients (27.7%). The proportions of bigger, just-fits, and smaller in liver cirrhosis versus non-liver cirrhosis patients were 51.8%, 21.4%, and 26.8% versus 77.4%, 11.4%, and 8.2% (p < 0.01). The proportions of grip strength decline in patients with bigger, just-fits, and smaller were 12.0% (77/142), 21.2% (7/33), and 40.7% (11/27; overall p < 0.01). The proportions of SMI decline in patients with bigger, just-fits, and smaller were 9.9% (14/142), 45.5% (15/33), and 77.8% (21/27; overall p < 0.01). The proportions of sarcopenia in patients with bigger, just-fits, and smaller were 3.5% (5/142), 18.2% (6/33), and 33.3% (9/27; overall p < 0.01). In both sexes, arm circumference, triceps skinfold thickness, calf circumference, and waist circumference were significantly stratified according to the finger-circle test. In the multivariate analysis, smaller was an independent predictor for SMI decline (p < 0.01, risk ratio 8.188, bigger as a reference), and body mass index was an independent predictor for both SMI decline and sarcopenia. CONCLUSION The finger-circle test can be helpful for the screening of sarcopenia in chronic liver disease and is closely linked to body composition.
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Affiliation(s)
- Hiroki Nishikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazunori Yoh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirayuki Enomoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Nishimura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Hiroko Iijima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Son SW, Song DS, Chang UI, Yang JM. Definition of Sarcopenia in Chronic Liver Disease. Life (Basel) 2021; 11:349. [PMID: 33923561 PMCID: PMC8074027 DOI: 10.3390/life11040349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 02/07/2023] Open
Abstract
Sarcopenia, which is characterized by decline in muscle mass, muscle strength, and physical performance, is common in patients with chronic liver disease (CLD) and is associated with poor clinical outcomes. Several consensus definitions for community-dwelling elderly people have been proposed, and these recommend the use of various tools and tests to assess muscle properties and performance. These measurement tools have also been applied in patients with CLD and have been useful for predicting prognosis. However, sarcopenia and its diagnostic criteria specific to patients with CLD have not yet been clearly defined. In addition, fluid retention and body composition should be considered when sarcopenia is assessed in patients with CLD. This review aims to introduce definitions of sarcopenia and diagnostic tools used in patients with CLD.
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Affiliation(s)
| | - Do Seon Song
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.W.S.); (U.I.C.); (J.M.Y.)
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Marasco G, Dajti E, Ravaioli F, Brocchi S, Rossini B, Alemanni LV, Peta G, Bartalena L, Golfieri R, Festi D, Colecchia A, Renzulli M. Clinical impact of sarcopenia assessment in patients with liver cirrhosis. Expert Rev Gastroenterol Hepatol 2021; 15:377-388. [PMID: 33196344 DOI: 10.1080/17474124.2021.1848542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Sarcopenia is defined as loss of skeletal muscle mass, strength, and function, and it is associated with increased morbidity and mortality in patients with chronic liver disease.Areas covered: The aim of this review is to provide a detailed report on the pathophysiological mechanisms underlying sarcopenia in cirrhotic patients, the several imaging methods available for the assessment of sarcopenia and the clinical studies evaluating the prognostic role of sarcopenia presence in cirrhotic patients.Expert opinion: Sarcopenia pathogenesis is complex and multifaceted, as chronic catabolic conditions, increased energy expenditure, reduced appetite, side effects of multiple therapies, alterations in circulating levels of hormones, low protein synthesis, presence of ascites or portosystemic shunts are all factors contributing to muscle atrophy in cirrhotic patients. Computed tomography scan is the most validated method to evaluate muscle mass and quality. Sarcopenia is associated with a higher rate waitlist mortality, hepatic encephalopathy, and lower quality of life in patients with liver cirrhosis. Future studies should make an effort to unify and validate liver disease-specific cutoffs for the definition of sarcopenia.
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Affiliation(s)
- Giovanni Marasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elton Dajti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Stefano Brocchi
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Benedetta Rossini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Giuliano Peta
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Laura Bartalena
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Matteo Renzulli
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
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Nishikawa H, Yoh K, Enomoto H, Nishimura T, Nishiguchi S, Iijima H. Combined grip strength and calf circumference as a useful prognostic system in patients with liver diseases: a large cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:624. [PMID: 33987322 PMCID: PMC8105999 DOI: 10.21037/atm-20-6901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Sarcopenia and body composition can be associated with mortality in chronic liver diseases (CLDs). We sought to identify predictors in CLD patients (n=631, 309 males) and create a prognostic model using easily available indexes. Methods Reference values for low-grip strength (GS) were 26 kg in men and 18 kg in women. Reference values for low-skeletal muscle index (SMI) were 7.0 kg/m2 in men and 5.7 kg/m2 in women using bioelectrical impedance analysis (BIA). Reference values for low-calf circumference (CC) were 34 cm in men and 33 cm in women. Reference values for high-waist circumference were 85 cm in men and 90 cm in women. Using significant factors in the multivariate analysis contributing to the overall survival (OS), we created a simple predictive model. Akaike information criterion (AIC) was compared. Results Men (P<0.0001), presence of liver cirrhosis (LC) (P<0.0001), presence of hepatocellular carcinoma (HCC) (P<0.0001), low-GS (P<0.0001), low-CC (P<0.0001), serum albumin (P=0.0355), estimated glomerular filtration rate (P=0.0461), hepatitis B virus (P=0.0044) and hepatitis C virus (P<0.0001) were significant factors contributing to the OS by the multivariate analysis. The study subjects were classified into the 4 groups (combined GS-SMI system): (I) low-GS and low-SMI (sarcopenia, n=73); (II) low-GS and high-SMI (n=65); (III) high-GS and low-SMI (n=110); and (IV) high-GS and high-SMI (n=383). The cumulative OS rates were well stratified among 4 groups (overall P<0.0001, AIC =360.895). The study subjects were also classified into the 4 groups (combined GS-CC system): (I) low-GS and low-CC (n=60); (II) low-GS and high-CC (n=78); (III) high-GS and low-CC (n=70); and (IV) high-GS and high-CC (n=423). The cumulative OS rates were also well stratified among 4 groups (overall P<0.0001, AIC =349.521). In receiver operating characteristic (ROC) curve analysis for CC based on the OS, the optimal cutoff point in men was 34.6 cm [area under the ROC (AUC) =0.70, sensitivity =0.558, specificity =0.842], and that in women was 32.8 cm (AUC =0.72, sensitivity =0.619, specificity =0.787). Conclusions CC can be an alternative marker for muscle mass in CLD patients. Our proposed combined GS-CC system can be helpful in the community settings without special equipment for muscle mass measurement.
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Affiliation(s)
- Hiroki Nishikawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazunori Yoh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirayuki Enomoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Nishimura
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Hiroko Iijima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Wang X, Feng H, Hui Y, Yu Z, Zhao T, Mao L, Lin L, Wang B, Fan X, Yu Q, Sun C. Neutrophil-to-lymphocyte ratio is associated with malnutrition risk estimated by the Royal Free Hospital-Nutritional Prioritizing Tool in hospitalized cirrhosis. JPEN J Parenter Enteral Nutr 2021; 46:123-129. [PMID: 33720443 DOI: 10.1002/jpen.2097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/16/2021] [Accepted: 02/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver cirrhosis is characterized by immune dysfunction, contributing to malnutrition. We previously revealed neutrophil-to-lymphocyte ratio (NLR) as an indicator of disordered immune system. Herein we aimed to (1) determine the optimal NLR cutoff that best predicts malnutrition risk and (2) clarify the association between NLR and nutrition status. METHODS A total of 135 hospitalized patients with cirrhosis were included. Immune dysfunction was evaluated by levels of serum C-reactive protein (CRP), NLR, and other parameters. Malnutrition was screened by a risk score referring to the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Receiver operating characteristic (ROC) curve was implemented to determine the best NLR cutoff that predicts malnutrition risk. Correlation between NLR and indicators of hepatic and physical function (handgrip strength) were also examined. Multivariable logistic regression was used to assess the association between NLR and malnutrition risk. RESULTS ROC curve revealed that the optimum cutoff to predict malnutrition risk was NLR > 4.2, with a sensitivity of 47.2%, specificity of 81.0%, negative predictive value of 58.0%, and positive predictive value of 74.5%, respectively. Patients with NLR > 4.2 exhibited a higher RFH-NPT score, serum platelet-to-lymphocyte ratio, and CRP. A positive correlation was found between NLR values and Child-Turcotte-Pugh (r = 0.22; P = .010), model for end-stage liver disease (r = 0.36; P < .001), and RFH-NPT scores (r = 0.31; P < .001). NLR was a risk factor for malnutrition independently of alcoholic liver disease and presence of ascites. CONCLUSIONS Immune dysfunction measured by NLR was associated with malnutrition risk estimated by RFH-NPT in cirrhosis.
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Affiliation(s)
- Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongjuan Feng
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Nutriology, Tianjin Third Central Hospital, Tianjin, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Zihan Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Tianming Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Lihong Mao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin Lin
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin Airport Economic Area, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingxiang Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin Airport Economic Area, Tianjin, China
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Prevalence and Nonpharmacological Interventions for Sarcopenia among Cirrhotic Patients. DISEASE MARKERS 2021; 2021:8866093. [PMID: 33628339 PMCID: PMC7884167 DOI: 10.1155/2021/8866093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 11/18/2022]
Abstract
Sarcopenia is the most common feature of hepatic cirrhosis characterized by progressive loss of muscle mass and function and increases permanently the mortality and morbidity rates among those patients. The incidence of sarcopenia in cirrhotic patients ranged 40-70% associating with impaired quality of life and augmented rates of infection. Based on these issues, this review is aimed at determining the prevalence and main causes of sarcopenia among cirrhotic patients and recognizing the recent diagnostic and physical treatment modalities that prevent risk factors for sarcopenia in those patients. No ideal modality is currently demonstrated for diagnosing sarcopenia in hepatic diseases, particularly cirrhosis; however, recent studies reported different diagnostic modalities for muscle function in different individuals including handgrip strength, skeletal muscle index, six-min walk test, liver frailty index, short physical performance battery, and radiological assessments for quadriceps and psoas muscles. Exercise training and therapeutic nutrition are strongly recommended for controlling sarcopenia in cirrhotic patients. The exercise program is designed and carried out on a frequent basis within an extensive scheduled time aimed at improving functional performance, aerobic capacity, and healthy conditions. Finally, a combination of exercise training and therapeutic nutrition is powerfully recommended to control sarcopenia in cirrhosis.
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Endo K, Sato T, Kakisaka K, Takikawa Y. Calf and arm circumference as simple markers for screening sarcopenia in patients with chronic liver disease. Hepatol Res 2021; 51:176-189. [PMID: 33141991 DOI: 10.1111/hepr.13589] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/05/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022]
Abstract
AIM To prevent the progression of sarcopenia, early identification is important. We investigated the usefulness of sarcopenia screening tests using the arm and calf circumferences in patients with chronic liver disease. METHODS This was a single-center cross-sectional study based on data collected from a university hospital. We analyzed simple anthropometric data and sarcopenia-related chemical data or imaging data between April and December 2019. Sarcopenia was defined according to the Japan Society of Hepatology guidelines. RESULTS In total, 661 patients participated. Low muscle mass and low muscle strength were found in 245 (37.1%) and 153 (23.1%) patients, respectively. Ultimately, 90 (13.6%) patients were diagnosed with sarcopenia. The sarcopenia group was significantly older and had a higher cirrhosis ratio and poorer liver function than the non-sarcopenia group. The sarcopenia group had a significantly lower body mass index, arm circumferences and calf circumferences than the non-sarcopenia group. A receiver operating characteristics analysis for diagnosing sarcopenia by arm and calf circumferences showed respective areas under the curve of 0.89 and 0.91 for men and 0.84 and 0.89 for women. The optimal cut-off values of arm and calf circumferences were respectively determined to be 25.0 and 32.6 cm for men (sensitivity 88.4% and 83.7%; specificity 74.0% and 84.7%) and 22.7 and 32.1 cm for women (sensitivity 66.0% and 85.1%; specificity 90.0% and 81.3%). CONCLUSIONS The arm and calf circumferences seem useful as simple surrogate markers for screening sarcopenia in patients with chronic liver disease.
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Affiliation(s)
- Kei Endo
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takuro Sato
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
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Zuberi FF, Zuberi BF, Ali FS, Bader N. Muscle weakness assessment in non-hypoxemic COPD out-patients at tertiary care hospitals. Pak J Med Sci 2021; 37:536-542. [PMID: 33679946 PMCID: PMC7931309 DOI: 10.12669/pjms.37.2.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To determine frequency of Muscle Weakness in Non-Hypoxemic COPD out-patients and Comparison with age matched non-COPD Controls. Methods: This cross-sectional study was conducted at OPD of Ojha Institute of Chest Diseases and Medicine, Dow University of Health Sciences, Karachi, Pakistan, during the period 8th September 2019 till 30th May 2020. Patients of both genders aged 25-70 years who were satisfying GOLD criteria for COPD and having SpO2 ≥ 94% were included. An age matched control group was added as control. Hand Grip Strength (HGS) and Chair to Stand time (CST) were recorded. Results: Two hundred fifty-six patients were inducted with aged and BMI matched group of non-COPD Control patients in ratio of 1:2 (n = 128). Comparison of HGS between Control and COPD Groups showed significant weakness in COPD group. Significant weakness in lower limbs in COPD Group with longer timings to complete the task. Mean FEV1 had significant low values in COPD Group. Age correlated negatively with HGS & positively with CST. BMI correlated positively with FEV1 and CST but negatively with HGS. HGS correlated positively with FEV1 and no correlation was found with CST. No correlation was found of CST with FEV1. Conclusion: Muscle weakness in COPD patients was shown by simple validated bedside tools. The older COPD patients had less HGS and were slower in doing CST whereas those COPD ones who had higher FEV1 had more HGS.
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Affiliation(s)
- Faisal Faiyaz Zuberi
- Faisal Faiyaz Zuberi, Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | - Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Sadaqat Ali
- Faiza Sadaqat Ali, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Nimrah Bader, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Kotoh Y, Saeki I, Yamasaki T, Sasaki R, Tanabe N, Oono T, Matsuda T, Hisanaga T, Matsumoto T, Hidaka I, Ishikawa T, Takami T, Sakaida I. Effect of Handgrip Strength on Clinical Outcomes of Patients with Hepatocellular Carcinoma Treated with Lenvatinib. APPLIED SCIENCES 2020; 10:5403. [DOI: 10.3390/app10165403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Previous studies have reported prognostic factors for hepatocellular carcinoma (HCC) patients receiving lenvatinib; however, no studies have evaluated the effects of both handgrip strength and skeletal muscle mass on the clinical outcomes. Therefore, this retrospective study investigated the individual effect of handgrip strength, skeletal muscle mass, and sarcopenia on clinical outcomes of 53 HCC patients treated with lenvatinib. Before receiving lenvatinib, handgrip strength and skeletal muscle index (SMI) were measured. Low handgrip strength and muscle depletion were defined as <26 and <18 kg and SMI <42 and SMI <38 cm2/m2 in men and women, respectively. Sarcopenia was defined as having low handgrip strength and muscle depletion. Multivariate analysis identified modified albumin–bilirubin grade 1–2a (p = 0.010), Barcelona Clinic Liver Cancer stage A–B (p = 0.011), and absence of low handgrip strength (p = 0.015) as favorable prognostic factors for survival. Furthermore, sarcopenia was an independent significant prognostic factor for survival. Time to treatment failure was associated with handgrip strength and sarcopenia. Our findings suggest that handgrip strength may be a useful marker of clinical outcomes in HCC patients treated with lenvatinib.
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Impact of Grip Strength in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib. Cancers (Basel) 2020; 12:cancers12082146. [PMID: 32756366 PMCID: PMC7465794 DOI: 10.3390/cancers12082146] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
Although sarcopenia is characterized by a loss of muscle strength and skeletal muscle mass, few studies have evaluated the effect of muscle strength on hepatocellular carcinoma (HCC) patients. We evaluated the impact of sarcopenia-related factors (grip strength (GS) and the skeletal muscle index (SMI)) on the survival among lenvatinib-treated unresectable HCC (u-HCC) patients. This single-center cohort study was conducted at a university hospital. The study population included 63 lenvatinib-treated u-HCC patients managed between April 2018 and April 2020. A decreased GS and decreased SMI were found in 21 (33.3%) and 22 (34.9%) patients, respectively. The overall survival (OS) of the normal GS group was significantly higher than that of the decreased GS group, while that of the normal and decreased SMI groups did not differ markedly. There were no significant differences in the progression-free survival between the normal GS and decreased GS groups or the normal SMI and decreased SMI groups. A multivariate Cox proportional hazards model showed that modified albumin-bilirubin-grade (mALBI) 2b (hazard ratio (HR) 4.39) and a decreased GS (HR 3.55) were independently associated with an increased risk of poor prognosis. In addition to the hepatic functional reserve, a decreased GS was a poor prognostic factor in lenvatinib-treated u-HCC patients.
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Nishikawa H, Enomoto H, Nishiguchi S, Iijima H. Liver Cirrhosis and Sarcopenia from the Viewpoint of Dysbiosis. Int J Mol Sci 2020; 21:E5254. [PMID: 32722100 PMCID: PMC7432211 DOI: 10.3390/ijms21155254] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Sarcopenia in patients with liver cirrhosis (LC) has been attracting much attention these days because of the close linkage to adverse outcomes. LC can be related to secondary sarcopenia due to protein metabolic disorders and energy metabolic disorders. LC is associated with profound alterations in gut microbiota and injuries at the different levels of defensive mechanisms of the intestinal barrier. Dysbiosis refers to a state in which the diversity of gut microbiota is decreased by decreasing the bacterial species and the number of bacteria that compose the gut microbiota. The severe disturbance of intestinal barrier in LC can result in dysbiosis, several bacterial infections, LC-related complications, and sarcopenia. Here in this review, we will summarize the current knowledge of the relationship between sarcopenia and dysbiosis in patients with LC.
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Affiliation(s)
- Hiroki Nishikawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya 6638136, Japan; (H.E.); (H.I.)
- Center for Clinical Research and Education, Hyogo College of Medicine, Nishinomiya 6638136, Japan
| | - Hirayuki Enomoto
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya 6638136, Japan; (H.E.); (H.I.)
| | | | - Hiroko Iijima
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya 6638136, Japan; (H.E.); (H.I.)
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Imai K, Takai K, Miwa T, Taguchi D, Hanai T, Suetsugu A, Shiraki M, Shimizu M. Rapid Depletion of Subcutaneous Adipose Tissue during Sorafenib Treatment Predicts Poor Survival in Patients with Hepatocellular Carcinoma. Cancers (Basel) 2020; 12:E1795. [PMID: 32635536 PMCID: PMC7407859 DOI: 10.3390/cancers12071795] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to assess the annualized changes in body composition, including skeletal muscle, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) before, during, and after sorafenib treatment in patients with hepatocellular carcinoma (HCC). This retrospective study evaluated 61 HCC patients treated with sorafenib. Annualized changes (Δ; cm2/m2/year) in skeletal muscle index (SMI), SAT index (SATI), and VAT index (VATI), which were defined as the cross-sectional areas (cm2) of those areas on computed tomography normalized by the square of one's height (m2), before (pre), during (during), and after (post) sorafenib treatment, were calculated. Patients within the 20th percentile cutoffs for these indices were classified into the rapid depletion group and the effects of these values on survival were analyzed using the Kaplan-Meier analysis and Cox proportional-hazards model. Annualized depletion rates of SMI (ΔSMIpre: -3.5, ΔSMIduring: -3.5, ΔSMIpost: -8.0) and VATI (ΔVATIpre: -3.2, ΔVATIduring: -2.8, ΔVATIpost: -15.1) accelerated after the cancellation of sorafenib, whereas that of SATI (ΔSATIpre: -4.8, ΔSATIduring; -7.6, ΔSATIpost; -8.0) had already accelerated during sorafenib treatment. Patients with rapid depletion of ΔSATIduring experienced significantly worse survival rates (p < 0.001), and it was an independent predictor of survival (p = 0.009), together with therapeutic effect (p < 0.001). Rapid depletion of SAT during sorafenib treatment can be used to predict survival in patients with HCC.
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Affiliation(s)
- Kenji Imai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan; (K.T.); (T.M.); (D.T.); (T.H.); (A.S.); (M.S.); (M.S.)
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Hou L, Deng Y, Fan X, Zhao T, Cui B, Lin L, Hou J, Mao L, Zhao W, Jiang K, Wang B, Zhang J, Sun C. A Sex-Stratified Prognostic Nomogram Incorporating Body Compositions for Long-Term Mortality in Cirrhosis. JPEN J Parenter Enteral Nutr 2020; 45:403-413. [PMID: 32359094 DOI: 10.1002/jpen.1841] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/28/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alterations in body compositions are related to poor outcomes and the presence of complications in cirrhosis. However, no predictive tools combining all these anthropometric parameters are applicable in the clinical setting. We aimed to clarify the potential utility of body compositions and develop a nomogram incorporating any independent factor for prognosticating long-term mortality in cirrhosis. METHODS A total of 414 patients were randomized into primary (n = 274) and validation (n = 140) cohorts. X-tile was performed to identify optimal cut points for stratifying participants. Multivariate Cox regression was performed, and nomogram incorporating body compositions were generated. The utility of developed models was evaluated by Harrell concordance index (C-index), calibration curve, and decision curve analysis (DCA). RESULTS Stratifying by X-tilederived cut points, low skeletal muscle index (myopenia), high intramuscular adipose tissue content (myosteatosis), and the ratio of high visceral to subcutaneous adipose tissue area (adiposity) was independently associated with 3-year mortality. A sex-stratified nomogram incorporating anthropometric indices and clinical factors resulted in moderate discriminative accuracy, with a C-index of 0.787 (95% CI, 0.736-0.838) and 0.789 (95% CI, 0.727-0.851) in males and females, respectively. The calibration curve showed predictive survival corresponding optimally with the actual outcomes. Our models were feasible in the clinical settings based on DCA. Similar results were observed in the validation cohort. Additionally, participants could be classified into 3 distinct risk groups by the nomogram. CONCLUSIONS Our proposed nomogram embedding body compositions rendered an individualized predictive tool for long-term mortality in cirrhosis.
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Affiliation(s)
- Lijun Hou
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - You Deng
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Tianming Zhao
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Lin Lin
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Junjie Hou
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Lihong Mao
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Zhao
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Kui Jiang
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Zhang
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin, Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
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Sinclair M. Controversies in Diagnosing Sarcopenia in Cirrhosis-Moving from Research to Clinical Practice. Nutrients 2019; 11:nu11102454. [PMID: 31615103 PMCID: PMC6836123 DOI: 10.3390/nu11102454] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
Sarcopenia, defined as loss of muscle mass and function, is increasingly recognized as a common consequence of advanced cirrhosis that is associated with adverse clinical outcomes. Despite the recent proliferation in publications pertaining to sarcopenia in end-stage liver disease, there remains no single 'best method' for its diagnosis. The inability to identify a gold standard is common to other specialties, including geriatrics from which many diagnostic tools are derived. Controversies in diagnosis have implications for the accuracy and reproducibility of cohort studies in the field, largely prohibit the introduction of sarcopenia measurement into routine patient care and impede the development of clinical trials to identify appropriate therapies. Difficulties in diagnosis are partly driven by our ongoing limited understanding of the pathophysiology of sarcopenia in cirrhosis, the mechanisms by which it impacts on patient outcomes, the heterogeneity of patient populations, and the accuracy, availability and cost of assessments of muscle mass and function. This review discusses the currently studied diagnostic methods for sarcopenia in cirrhosis, and outlines why reaching a consensus on sarcopenia diagnosis is important and suggests potential ways to improve diagnostic criteria to allow us to translate sarcopenia research into improvements in clinical care.
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Affiliation(s)
- Marie Sinclair
- Department of Medicine, The University of Melbourne, Parkville 3050, Australia.
- Austin Health, Liver Transplant Unit, 145 Studley Road, Heidelberg 3084, Australia.
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