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Zhu Y, Guo C, Fan H, Han X, Li Y, Chen X, Zhang T. Serum Branched-Chain Amino Acids and Long-Term Complications of Liver Cirrhosis: Evidence from a Population-Based Prospective Study. Nutrients 2024; 16:2295. [PMID: 39064737 PMCID: PMC11279618 DOI: 10.3390/nu16142295] [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: 06/18/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND AND AIMS The role of serum branched-chain amino acids (BCAAs) in long-term liver cirrhosis complication events remains unclear. We aimed to evaluate the associations between serum BCAAs and the risk of liver-related events. METHODS We included a total of 64,005 participants without liver cirrhosis complication events at baseline from the UK Biobank. Cox proportional hazards regression models were utilized to estimate multivariable hazard ratios (HRs) and 95% CIs for the incidence of liver cirrhosis complication events, adjusting for potential confounders, including sociodemographic and lifestyle factors. Relationships between serum BCAAs and liver cirrhosis complications were examined using nonparametrically restricted cubic spline regression. RESULTS During a median follow-up of 12.7 years, 583 participants developed liver cirrhosis complication events. The multivariable Cox regression model suggested that total BCAAs (HR = 0.88, 95% CI 0.82-0.95), serum leucine (HR = 0.88, 95% CI 0.81-0.95), serum isoleucine (HR = 0.88, 95% CI 0.82-0.96), and serum valine (HR = 0.87, 95% CI 0.82-0.96) were all independent protective factors for liver cirrhosis complications after adjustment for sociodemographic and lifestyle factors. Cox models with restricted cubic splines showed U-shaped associations between serum valine and liver cirrhosis complication incidence. Serum total BCAA and isoleucine concentrations might reduce the risk of liver cirrhosis complications by raising the risk of (type 2 diabetes mellitus) T2DM. CONCLUSION Lower serum BCAA levels exacerbate the long-term risk of liver cirrhosis complications. Future studies should confirm these findings and identify the biological pathways of these associations.
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Affiliation(s)
- Yichen Zhu
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200437, China; (Y.Z.); (C.G.); (H.F.); (X.H.); (Y.L.); (X.C.)
- Key Laboratory of Public Health Safety, Department of Epidemiology, School of Public Health, Ministry of Education, Fudan University, Shanghai 200437, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou 176002, China
| | - Chengnan Guo
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200437, China; (Y.Z.); (C.G.); (H.F.); (X.H.); (Y.L.); (X.C.)
- Key Laboratory of Public Health Safety, Department of Epidemiology, School of Public Health, Ministry of Education, Fudan University, Shanghai 200437, China
| | - Hong Fan
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200437, China; (Y.Z.); (C.G.); (H.F.); (X.H.); (Y.L.); (X.C.)
- Key Laboratory of Public Health Safety, Department of Epidemiology, School of Public Health, Ministry of Education, Fudan University, Shanghai 200437, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou 176002, China
| | - Xinyu Han
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200437, China; (Y.Z.); (C.G.); (H.F.); (X.H.); (Y.L.); (X.C.)
- Key Laboratory of Public Health Safety, Department of Epidemiology, School of Public Health, Ministry of Education, Fudan University, Shanghai 200437, China
| | - Yi Li
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200437, China; (Y.Z.); (C.G.); (H.F.); (X.H.); (Y.L.); (X.C.)
- Key Laboratory of Public Health Safety, Department of Epidemiology, School of Public Health, Ministry of Education, Fudan University, Shanghai 200437, China
| | - Xingdong Chen
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200437, China; (Y.Z.); (C.G.); (H.F.); (X.H.); (Y.L.); (X.C.)
- Fudan University Taizhou Institute of Health Sciences, Taizhou 176002, China
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai 200438, China
- Human Phenome Institute, Fudan University, 825 Zhangheng Road, Shanghai 200437, China
| | - Tiejun Zhang
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai 200437, China; (Y.Z.); (C.G.); (H.F.); (X.H.); (Y.L.); (X.C.)
- Key Laboratory of Public Health Safety, Department of Epidemiology, School of Public Health, Ministry of Education, Fudan University, Shanghai 200437, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou 176002, China
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Miwa T, Utakata Y, Hanai T, Aiba M, Unome S, Imai K, Takai K, Shiraki M, Katsumura N, Shimizu M. Acute kidney injury development is associated with mortality in Japanese patients with cirrhosis: impact of amino acid imbalance. J Gastroenterol 2024:10.1007/s00535-024-02126-7. [PMID: 38861012 DOI: 10.1007/s00535-024-02126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious complication of cirrhosis. This study analyzed the prognostic effect of AKI in patients with cirrhosis and its risk factors, particularly in relation to amino acid imbalance. METHODS This retrospective study reviewed 808 inpatients with cirrhosis at two institutes in Gifu, Japan. AKI was diagnosed according to the recommendations of the International Club of Ascites. Amino acid imbalance was assessed by measuring serum branched-chain amino acid (BCAA) levels, tyrosine levels, and the BCAA-to-tyrosine ratio (BTR). Factors associated with mortality and AKI development were assessed using the Cox proportional hazards regression model with AKI as a time-dependent covariate and the Fine-Gray competing risk regression model, respectively. RESULTS Of the 567 eligible patients without AKI at baseline, 27% developed AKI and 25% died during a median follow-up period of 4.7 years. Using a time-dependent covariate, AKI development (hazard ratio [HR], 6.25; 95% confidence interval [CI], 3.98-9.80; p < 0.001) was associated with mortality in patients with cirrhosis independent of potential covariates. In addition, alcohol-associated/-related liver disease, metabolic dysfunction-associated steatohepatitis, Child-Pugh score, and BTR (subdistribution HR 0.78; 95% CI 0.63-0.96; p = 0.022) were independently associated with AKI development in patients with cirrhosis. Similar results were obtained in the multivariate model that included BCAA and tyrosine levels instead of BTR. CONCLUSIONS AKI is common and associated with mortality in Japanese patients with cirrhosis. An amino acid imbalance is strongly associated with the development of AKI in patients with cirrhosis.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Yuki Utakata
- Department of Gastroenterology, Chuno Kosei Hospital, Gifu, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masashi Aiba
- Department of Gastroenterology, Chuno Kosei Hospital, Gifu, Japan
| | - Shinji Unome
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Makoto Shiraki
- Department of Gastroenterology, Chuno Kosei Hospital, Gifu, Japan
| | - Naoki Katsumura
- Department of Gastroenterology, Chuno Kosei Hospital, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Mino M, Sano A, Kakazu E, Matsubara H, Kakisaka K, Kogure T, Sekine K, Aoki Y, Imamura M, Matsuda M, Yamazoe T, Mori T, Yoshio S, Inoue J, Masamune A, Kanto T. Differences in branched-chain amino acid to tyrosine ratio (BTR) among etiologies of chronic liver disease progression compared to healthy adults. J Gastroenterol 2024; 59:483-493. [PMID: 38530472 DOI: 10.1007/s00535-024-02092-0] [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: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The branched-chain amino acids (BCAAs) to tyrosine (Tyr) ratio (BTR) test is used to evaluate the progression of chronic liver disease (CLD). However, the differences across sex, age, body mass index (BMI) and etiologies are still unclear. METHODS We retrospectively reviewed data from 2,529 CLD cases with free amino acids (FAAs) in peripheral blood from four hospitals and 16,421 general adults with FAAs data from a biobank database. In total, 1,326 patients with CLD (covering seven etiologies) and 8,086 healthy controls (HCs) were analyzed after exclusion criteria. We investigated the change of BTR in HCs by sex, age and BMI and then compared these to patients divided by modified ALBI (mALBI) grade after propensity score matching. RESULTS BTR is significantly higher in males than females regardless of age or BMI and decreases with aging in HCs. In 20 types of FAAs, 7 FAAs including BCAAs were significantly decreased, and 11 FAAs including Tyr were significantly increased by mALBI grade in total CLD. The decreasing timings of BTR were at mALBI grade 2b in all CLD etiologies compared to HCs, however in chronic hepatitis C (CHC), chronic hepatitis B (CHB) and alcoholic liver disease (ALD), BTR started to decrease at 2a. There was a positive correlation between BCAAs and albumin among parameters in BTR and mALBI. The correlation coefficients in PBC, ALD and MASLD were higher than those of other etiologies. CONCLUSIONS BTR varies by sex and age even among healthy adults, and decreasing process and timing of BTR during disease progression is different among CLD etiologies.
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Affiliation(s)
- Masaaki Mino
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Akitoshi Sano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aobaku, Sendai, 980-8574, Japan
| | - Eiji Kakazu
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aobaku, Sendai, 980-8574, Japan.
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
| | - Hiroko Matsubara
- Department of Biobank, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo, Aobaku, Sendai, 980-0872, Japan
| | - Keisuke Kakisaka
- Division of Gastroenterology and Hepatology, Iwate Medical University School of Medicine, 2-1-1, Idaidori, Yahabacho, Shiwagun, Iwate, Japan
| | - Takayuki Kogure
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University Miyagi, 1-15-1, Fukumuro, Miyaginoku, Sendai, 983-8536, Japan
| | - Katsunori Sekine
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Yoshihiko Aoki
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Masatoshi Imamura
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Michitaka Matsuda
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Taiji Yamazoe
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Taizo Mori
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Sachiyo Yoshio
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
| | - Jun Inoue
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aobaku, Sendai, 980-8574, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aobaku, Sendai, 980-8574, Japan
| | - Tatsuya Kanto
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
- Department of Liver Diseases, The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, 272-8516, Japan
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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. [PMID: 38700075 DOI: 10.1111/jgh.16590] [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: 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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Matsui M, Asai A, Ushiro K, Onishi S, Nishikawa T, Ohama H, Tsuchimoto Y, Kim SK, Nishikawa H. Prognostic Nutritional Index Correlates with Liver Function and Prognosis in Chronic Liver Disease Patients. Diagnostics (Basel) 2023; 14:49. [PMID: 38201358 PMCID: PMC10802838 DOI: 10.3390/diagnostics14010049] [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: 11/03/2023] [Revised: 12/23/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
The Prognostic Nutritional Index (PNI) is widely recognized as a screening tool for nutrition. We retrospectively examined the impact of PNI in patients with chronic liver disease (CLD, n = 319, median age = 71 years, 153 hepatocellular carcinoma (HCC) patients) as an observational study. Factors associated with PNI < 40 were also examined. The PNI correlated well with the albumin-bilirubin (ALBI) score and ALBI grade. The 1-year cumulative overall survival rates in patients with PNI ≥ 40 (n = 225) and PNI < 40 (n = 94) were 93.2% and 65.5%, respectively (p < 0.0001). In patients with (p < 0.0001) and without (p < 0.0001) HCC, similar tendencies were found. In the multivariate analysis, hemoglobin (p = 0.00178), the presence of HCC (p = 0.0426), and ALBI score (p < 0.0001) were independent factors linked to PNI < 40. Receiver operating characteristic (ROC) curve analysis based on survival for the PNI yielded an area under the ROC curve of 0.79, with sensitivity of 0.80, specificity of 0.70, and an optimal cutoff point of 42.35. In conclusion, PNI can be a predictor of nutritional status in CLD patients. A PNI of <40 can be useful in predicting the prognosis of patients with CLD.
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Affiliation(s)
- Masahiro Matsui
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Akira Asai
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
- Liver Center, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Kosuke Ushiro
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Saori Onishi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Tomohiro Nishikawa
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Hideko Ohama
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Yusuke Tsuchimoto
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Soo Ki Kim
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-8501, Hyogo, Japan
| | - Hiroki Nishikawa
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
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Yap KY, Chi H, Ng S, Ng DHL, Shelat VG. Effect of perioperative branched chain amino acids supplementation in liver cancer patients undergoing surgical intervention: A systematic review. World J Gastrointest Surg 2023; 15:2596-2618. [PMID: 38111761 PMCID: PMC10725538 DOI: 10.4240/wjgs.v15.i11.2596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/15/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Branched chain amino acid (BCAA) supplementation has been associated with favourable outcomes in liver malignancies requiring definitive resection or liver transplantation. Currently, there are no updated systematic reviews evaluating the efficacy of perioperative BCAA supplementation in patients undergoing surgery for liver cancer. AIM To evaluate the efficacy of perioperative BCAA supplementation in patients undergoing surgery for liver cancer. METHODS A systematic review of randomized control trials and observational studies was conducted on PubMed, Embase, Cochrane Library, Scopus, and Web of Science to evaluate the effect of perioperative BCAA supplementation compared to standard in-hospital diet, in liver cancer patients undergoing surgery. Clinical outcomes were extracted, and a meta-analysis was performed on relevant outcomes. RESULTS 16 studies including 1389 patients were included. Perioperative BCAA administration was associated with reduced postoperative infection [risk ratio (RR) = 0.58 95% confidence intervals (CI): 0.39 to 0.84, P = 0.005] and ascites [RR = 0.57 (95%CI: 0.38 to 0.85), P = 0.005]. There was also a reduction in length of hospital stay (LOS) [weighted mean difference (WMD) = -3.03 d (95%CI: -5.49 to -0.57), P = 0.02] and increase in body weight [WMD = 1.98 kg (95%CI: 0.35 to 3.61, P = 0.02]. No significant differences were found in mortality, cancer recurrence and overall survival. No significant safety concerns were identified. CONCLUSION Perioperative BCAA administration is efficacious in reducing postoperative infection, ascites, LOS, and increases body weight in liver cancer patients undergoing surgical resection.
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Affiliation(s)
- Kwan Yi Yap
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - HongHui Chi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Sherryl Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Doris HL Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
| | - Vishal G Shelat
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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7
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Daftari G, Tehrani AN, Pashayee-Khamene F, Karimi S, Ahmadzadeh S, Hekmatdoost A, Salehpour A, Saber-Firoozi M, Hatami B, Yari Z. Dietary protein intake and mortality among survivors of liver cirrhosis: a prospective cohort study. BMC Gastroenterol 2023; 23:227. [PMID: 37400778 DOI: 10.1186/s12876-023-02832-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/24/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Liver cirrhosis is a worldwide burden and is associated with poor clinical outcomes, including increased mortality. The beneficial effects of dietary modifications in reducing morbidity and mortality are inevitable. AIM The current study aimed to evaluate the potential association of dietary protein intake with the cirrhosis-related mortality. METHODS In this cohort study, 121 ambulatory cirrhotic patients with at least 6 months of cirrhosis diagnosis were followed-up for 48 months. A 168-item validated food frequency questionnaire was used for dietary intake assessment. Total dietary protein was classified as dairy, vegetable and animal protein. We estimated crude and multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), applying Cox proportional hazard analyses. RESULTS After full adjustment for confounders, analyses showed that total (HR = 0.38, 95% CI = 0.2-1.1, p trend = 0.045) and dairy (HR = 0.38, 95% CI = 0.13-1.1, p trend = 0.046) protein intake was associated with a 62% lower risk of cirrhosis-related mortality. While a higher intake of animal protein was associated with a 3.8-fold increase in the risk of mortality in patients (HR = 3.8, 95% CI = 1.7-8.2, p trend = 0.035). Higher intake of vegetable protein was inversely but not significantly associated with mortality risk. CONCLUSION A comprehensive evaluation of the associations of dietary protein intake with cirrhosis-related mortality indicated that a higher intakes of total and dairy protein and a lower intakes of animal protein are associated with a reduced risk of mortality in cirrhotic patients.
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Affiliation(s)
- Ghazal Daftari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Asal Neshatbini Tehrani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fereshteh Pashayee-Khamene
- Clinical Nutrition and Dietetics Department, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, Tehran, Iran
| | - Sara Karimi
- Clinical Nutrition and Dietetics Department, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, Tehran, Iran
| | - Saleheh Ahmadzadeh
- Clinical Nutrition and Dietetics Department, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, Tehran, Iran
| | - Azita Hekmatdoost
- Clinical Nutrition and Dietetics Department, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences Tehran, Tehran, Iran
| | - Amin Salehpour
- Occupational Health Research Center, School of Public Health, Iran University of Medical Science, Tehran, Iran
| | - Mahdi Saber-Firoozi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Behzad Hatami
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Yari
- Department of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences Tehran, West Arghavan St. Farahzadi Blvd., Sharake Qods, Tehran, Iran.
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Manabe T, Ogawa C, Takuma K, Nakahara M, Oura K, Tadokoro T, Fujita K, Tani J, Shibatoge M, Morishita A, Kudo M, Masaki T. Usefulness of the Measurement of Psoas Muscle Volume for Sarcopenia Diagnosis in Patients with Liver Disease. Diagnostics (Basel) 2023; 13:diagnostics13071245. [PMID: 37046463 PMCID: PMC10093033 DOI: 10.3390/diagnostics13071245] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Computed tomography (CT) is often used in the diagnosis of sarcopenia. In this study, we validated the assessment of sarcopenia by the psoas muscle volume using versatile software. The study involved a retrospective analysis of data from 190 patients with liver disease who underwent grip-strength testing and abdominal pelvic computed tomography. To assess sarcopenia, SYNAPSE 3D was used to obtain the skeletal muscle index, the psoas muscle index (PMI), and the simple method. We also used the recently proposed PMI cutoff values, for which the usefulness has been evaluated (O-PMI). The cutoff value of the psoas muscle volume index (PMVI) was determined using one of the diagnostic methods as the gold standard. All diagnostic methods showed that patients with sarcopenia had shorter survival, with O-PMI having the highest hazard ratio (HR) (HR, 6.12; 95% confidence interval [CI], 2.6–14.41; p < 0.001). Even when sarcopenia could not be diagnosed by O-PMI, low PMVI was associated with shorter survival (HR, 3.53; 95% CI, 1.34–9.32; p = 0.01). PMVI may be useful in the evaluation of sarcopenia, including the identification of poor overall survival in cases that cannot be diagnosed by O-PMI, which is considered more useful than PMI.
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9
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Chi Q, Wang D, Sun T, Liang HP. Integrated bioinformatical and in vitro study on drug targets for liver cirrhosis based on unsupervised consensus clustering and immune cell infiltration. Front Pharmacol 2023; 13:909668. [PMID: 36686655 PMCID: PMC9846563 DOI: 10.3389/fphar.2022.909668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/02/2022] [Indexed: 01/06/2023] Open
Abstract
Liver cirrhosis is one of the most common cause of death in the world. The progress of liver cirrhosis involves health, liver cirrhosis and liver cancer, leading to great challenges in the diagnosis of the disease. Drug targets, which could be obtained conveniently, can help clinicians improve prognosis and treatment. Liver cirrhosis is associated with serum calcium levels. And studies reported Tanshinone IIA plays a therapeutic role in liver injury through activating calcium-dependent apoptosis. In this study, we explored the diagnostic key targets of Tanshinone IIA in liver cirrhosis through exploration of comprehensive dataset including health, liver cirrhosis and liver cancer patients. The unsupervised consensus clustering algorithm identified 3 novel subtypes in which differentially expressed genes (DEGs) between both subtypes were found by pairwise comparison. Then, 4 key drug targets of Tanshinone IIA were determined through the intersection of these DEGs. The diagnostic performance of target genes was assessed and further verified in the external dataset. We found that the 4 key drug targets could be used as effective diagnostic biomarkers. Then the immune scores in the high and low expression groups of target genes were estimated to identify significantly expressed immune cells. In addition, the immune infiltration of high and low target gene expression groups in several immune cells were significantly different. The findings suggest that 4 key drug targets may be a simple and useful diagnostic tool for predicting patients with cirrhosis. We further studied the carcinogenesis role of AKR1C3 and TPX2 in vitro. Both mRNA and protein expression in hepatoma carcinoma cells was detected using qRT-PCR and Western blot. And the knockdown of AKR1C3 and TPX2 significantly suppressed cell proliferation, migration and invasion.
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Affiliation(s)
- Qingjia Chi
- Department of Engineering Structure and Mechanics, School of Science, Wuhan University of Technology, Wuhan, China,State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Infection and Drug, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Di Wang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Ting Sun
- Surgical Laboratory, General Hospital of Ningxia Medical University,, Yinchuan, Ningxia, China,Correspondence: Ting Sun, ; Hua-Ping Liang,
| | - Hua-Ping Liang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Infection and Drug, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China,Correspondence: Ting Sun, ; Hua-Ping Liang,
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10
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Miwa T, Hanai T, Nishimura K, Unome S, Maeda T, Ogiso Y, Imai K, Suetsugu A, Takai K, Shimizu M. Usefulness of the Global Leadership Initiative on Malnutrition criteria to predict sarcopenia and mortality in patients with chronic liver disease. Hepatol Res 2022; 52:928-936. [PMID: 35861232 DOI: 10.1111/hepr.13816] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 12/13/2022]
Abstract
AIM The Global Leadership Initiative on Malnutrition (GLIM) criteria, a newly developed global consensus around core diagnostic criteria for malnutrition, needs validation studies for use in daily clinical settings. This study aimed to determine whether the GLIM criteria could predict sarcopenia and mortality in patients with chronic liver disease (CLD). METHODS We retrospectively reviewed 858 patients with CLD who were treated at our hospital between March 2013 and December 2019. Sarcopenia was diagnosed based on the criteria proposed by the Japan Society of Hepatology. Malnutrition was assessed using the GLIM criteria, subjective global assessment (SGA), and Royal Free Hospital-global assessment (RFH-GA) and their predictive ability for sarcopenia and mortality were assessed using the logistic regression analysis and the Cox proportional hazards regression model, respectively. RESULTS Among the eligible 406 patients, 67% were men, the median age was 74 years, and 26% had sarcopenia. The prevalence of malnutrition according to the GLIM criteria, SGA, and RFH-GA was 21%, 35%, and 26%, respectively. Comparing malnourished with well-nourished patients, the odds ratio for complicating sarcopenia was 2.54 (95% confidence interval [CI], 1.44-4.49) for the GLIM criteria, 2.13 (95% CI, 1.09-4.15) for the SGA, and 2.78 (95% CI, 1.56-4.95) for the RFH-GA. During a median follow-up period of 2.0 years, 176 (43%) patients died. After adjusting for confounding factors, the GLIM criteria could independently predict mortality (hazard ratio, 1.95; 95% CI, 1.37-2.81). CONCLUSIONS The GLIM criteria are useful in identifying sarcopenia and predicting mortality in patients with CLD.
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Affiliation(s)
- Takao Miwa
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, 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
| | - Shinji Unome
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Toshihide Maeda
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yui Ogiso
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan.,Division for Regional Cancer Control, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Graduate School of Medicine, Gifu University, Gifu, Japan
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11
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Kodama S, Togami W, Miyamoto T. Psoas Major Skeletal Muscle Mass Is a Predictive Factor for Independent Walking After Living Donor Liver Transplantation. Transplant Proc 2022; 54:2285-2294. [PMID: 36116946 DOI: 10.1016/j.transproceed.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/05/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mobility affects the ability of patients to live independently post-discharge. This study aimed to identify factors affecting the achievement of independent walking in patients after living donor liver transplantation (LDLT). METHODS This retrospective cohort study involved 40 patients who had undergone LDLT for severe hepatic dysfunction (Child-Pugh class C) in the Department of Transplant Surgery of our hospital between January 2010 and October 2019 and received physiotherapy during hospital admission. To identify factors associated with independent walking, we classified patients based on their ability to walk independently. We performed multiple logistic regression analyses with the patients' attributes, biochemical tests, and physical function, considering the achievement or non-achievement of independent walking as dependent variables, and factors that were significantly different between the 2 groups in the univariate analysis (P < .05) as independent variables, after adjusting for age, sex, and body mass index. Moreover, we calculated cutoff values from the receiver operating characteristic (ROC) curves. RESULTS All patients suffered from severe hepatic dysfunction (Child-Pugh class C). The mobility Functional Independence Measure score following rehabilitation was positively correlated with the psoas major muscle index within 1 month after LDLT and at the beginning of physiotherapy. The only factor associated with achieving independent walking at the end of physiotherapy (on discharge) was the psoas major muscle index within 1 month of LDLT (odds ratio = 35.03, P < .05), and its cutoff value, calculated from the ROC curves curve, was 4.46. CONCLUSION Psoas major skeletal muscle mass is a reliable index for independent walking after LDLT.
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Affiliation(s)
- Satoru Kodama
- Department of Medical Technology, Division of Rehabilitation Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Wakana Togami
- Department of Physical Medicine and Rehabilitation, Kumamoto University Hospital, Kumamoto, Japan
| | - Takeshi Miyamoto
- Department of Physical Medicine and Rehabilitation, Kumamoto University Hospital, Kumamoto, Japan; Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
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12
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Hepatic Encephalopathy: Current and Emerging Treatment Modalities. Clin Gastroenterol Hepatol 2022; 20:S9-S19. [PMID: 35940731 DOI: 10.1016/j.cgh.2022.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
Hepatic encephalopathy (HE) is a potentially reversible neurocognitive complication of cirrhosis. It has been reported in at least 30% of patients with cirrhosis and imposes a significant economic burden on caregivers and the healthcare system. Ammonia has been recognized as the culprit in HE development, and all the currently approved treatments mostly act on this toxin to help with HE resolution. After a brief overview of HE characteristics and pathophysiology, this review explores the current accepted treatments for this debilitating complication of cirrhosis. This is followed by an overview of the novel available therapies and a brief focus on future treatment modalities for HE.
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13
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Wang X, Yu H, Xing R, Li P. Hepatoprotective Effect of Oyster Peptide on Alcohol-Induced Liver Disease in Mice. Int J Mol Sci 2022; 23:ijms23158081. [PMID: 35897657 PMCID: PMC9332721 DOI: 10.3390/ijms23158081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023] Open
Abstract
Alcohol-induced liver disease (ALD) has become one of the major global health problems, and the aim of this study was to investigate the characterization of the structure as well as the hepatoprotective effect and mechanism of oyster peptide (OP, MW < 3500 Da) on ALD in a mouse model. The results demonstrate that ethanol administration could increase the activities of aspartate aminotransferase (AST), alanine transaminase (ALT), γ-Glutamyl transferase (GGT), reactive oxygen species (ROS), malondialdehyde (MDA), and triglycerides (TG), as well as increase the interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α) levels (p < 0.01), and reduce the activity of superoxide dismutase (SOD) and the concentration of glutathione (GSH). Those changes were significantly reversed by the application of different doses of OP. Furthermore, the mRNA expressions of nuclear factor elythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and quinone oxidoreductase1 (NQO1) were significantly up-regulated in OP groups, and the mRNA expressions of nuclear factor kappa-light chain enhancer of B cells (NF-κB), TNF-α, and IL-6 were markedly reduced in OP groups compared to that of the model group. Thus, OP had a significant protective effect on ALD through the enhancement of the in vivo antioxidant ability and the inhibition of the inflammatory response as possible mechanisms of action, which therefore suggests that OP might be useful as a natural source to protect the liver from alcohol damage.
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Affiliation(s)
- Xueqin Wang
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; (X.W.); (H.Y.); (R.X.)
- Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
| | - Huahua Yu
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; (X.W.); (H.Y.); (R.X.)
- Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
| | - Ronge Xing
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; (X.W.); (H.Y.); (R.X.)
- Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
| | - Pengcheng Li
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; (X.W.); (H.Y.); (R.X.)
- Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
- Correspondence: ; Tel./Fax: +86-532-8289-8707
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14
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Eom JS, Lee SJ, Kim HS, Choi Y, Jo SU, Lee SS, Kim ET, Lee SS. Metabolic profiling of serum and urine in lactating dairy cows
affected by subclinical ketosis using proton nuclear magnetic resonance
spectroscopy. JOURNAL OF ANIMAL SCIENCE AND TECHNOLOGY 2022; 64:247-261. [PMID: 35530404 PMCID: PMC9039949 DOI: 10.5187/jast.2022.e14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/20/2022]
Abstract
Ketosis is associated with high milk yield during lactating or insufficient feed
intake in lactating dairy cows. However, few studies have been conducted on the
metabolomics of ketosis in Korean lactating dairy cows. The present study aimed
to investigate the serum and urine metabolites profiling of lactating dairy cows
through proton nuclear magnetic resonance (1H-NMR) spectroscopy and
comparing those between healthy (CON) and subclinical ketosis (SCK) groups. Six
lactating dairy cows were categorized into CON and SCK groups. All experimental
Holstein cows were fed total mixed ration. Serum and urine samples were
collected from the jugular vein of the neck and by hand sweeping the perineum,
respectively. The metabolites in the serum and urine were determined using
1H-NMR spectroscopy. Identification and quantification of
metabolites was performed by Chenomx NMR Suite 8.4 software. Metabolites
statistical analysis was performed by Metaboanalyst version 5.0 program. In the
serum, the acetoacetate level was significantly (p <
0.05) higher in the SCK group than in the CON group, and whereas acetate,
galactose and pyruvate levels tended to be higher. CON group had significantly
(p < 0.05) higher levels of 5-aminolevulinate and
betaine. Indole-3-acetate, theophylline, p-cresol, 3-hydroxymandelate,
gentisate, N-acetylglucosamine,
N-nitrosodimethylamine, xanthine and pyridoxine levels were
significantly (p < 0.05) higher in the urine of the SCK
group than that in the CON group, which had higher levels of homogentisate,
ribose, gluconate, ethylene glycol, maltose, 3-methyl-2-oxovalerate and
glycocholate. Some significantly (p < 0.05) different
metabolites in the serum and urine were associated with ketosis diseases,
inflammation, energy balance and body weight. This study will be contributed
useful a future ketosis metabolomics studies in Korea.
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Affiliation(s)
- Jun Sik Eom
- Institute of Agriculture and Life Science,
Gyeongsang National University, Jinju 52828, Korea
| | - Shin Ja Lee
- Institute of Agriculture and Life Science,
Gyeongsang National University, Jinju 52828, Korea
- University Centered Labs, Gyeongsang
National University, Jinju 52828, Korea
| | - Hyun Sang Kim
- Institute of Agriculture and Life Science,
Gyeongsang National University, Jinju 52828, Korea
| | - Youyoung Choi
- Division of Applied Life Science (BK21),
Gyeongsang National Universitiy, Jinju 52828, Korea
| | - Seong Uk Jo
- Division of Applied Life Science (BK21),
Gyeongsang National Universitiy, Jinju 52828, Korea
| | - Sang Suk Lee
- Ruminant Nutrition and Anaerobe
Laboratory, Department of Animal Science and Technology, Sunchon National
University, Suncheon 57922, Korea
| | - Eun Tae Kim
- Dairy Science Division, National Institute
of Animal Science, Rural Development Administration, Cheonan
31000, Korea
| | - Sung Sill Lee
- Institute of Agriculture and Life Science,
Gyeongsang National University, Jinju 52828, Korea
- University Centered Labs, Gyeongsang
National University, Jinju 52828, Korea
- Division of Applied Life Science (BK21),
Gyeongsang National Universitiy, Jinju 52828, Korea
- Corresponding author: Sung Sill Lee, Division of
Applied Life Science (BK21) & Institute of Agriculture and Life Science,
Gyeongsang National University, Jinju 52828, Korea. Tel: +82-55-772-1883,
E-mail:
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15
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Adding Branched-Chain Amino Acids to an Enhanced Standard-of-Care Treatment Improves Muscle Mass of Cirrhotic Patients With Sarcopenia: A Placebo-Controlled Trial. Am J Gastroenterol 2021; 116:2241-2249. [PMID: 34074812 DOI: 10.14309/ajg.0000000000001301] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The effect of branched-chain amino acid (BCAA) supplementation on muscle mass in patients with cirrhosis and sarcopenia is unknown. METHODS This is a pilot, prospective, randomized, and double-blind study of a cohort of 32 patients with cirrhosis and sarcopenia diagnosed by computed tomography scan who underwent a nutritional and physical activity intervention for 12 weeks. They were divided into 2 groups (placebo: 17 patients; BCAA: 15 patients). The study protocol was registered at ClinicalTrials.gov (NCT04073693). RESULTS Baseline characteristics were similar in both groups. After treatment, only the BCAA group presented a significant improvement in muscle mass (43.7 vs 46 cm2/m2; P = 0.023). Seventeen patients (63%) presented improvement in muscle mass overall, which was more frequent in the BCAA group (83.3 vs 46.7%; P = 0.056). Regarding frailty, there was a significant improvement in the Liver Frailty Index in the global cohort (n = 32) after the 12 weeks (4.2 vs 3.9; P < 0.001). This difference was significant in both groups: in the placebo group (4.2 vs 3.8; P < 0.001) and in the BCAA group (4.2 vs 3.9; P < 0.001). After treatment, the BCAA group had a higher increase in zinc levels than the placebo group (Δzinc: 12.3 vs 5.5; P = 0.026). In addition, there was a trend for greater improvement of albumin levels in the BCAA group (Δalbumin: 0.19 vs 0.04; P = 0.091). DISCUSSION BCAA supplementation improves muscle mass in cirrhotic patients with sarcopenia.
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Corrêa FCCR, Mira PADC, Pace FHDL, Laterza MC, Trevizan PF, Martinez DG. REDUCED PERIPHERAL AND INSPIRATORY MUSCLE ENDURANCE IN PATIENTS WITH LIVER CIRRHOSIS: A CROSS-SECTIONAL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:308-315. [PMID: 34705964 DOI: 10.1590/s0004-2803.202100000-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P<0.001) and inspiratory muscle exercises (40 vs 114 s, P<0.001). The peripheral muscle endurance was directly correlated with the total quality of life score (r=0.439, P=0.01) and to the following domains: fatigue (r=0.378 e P=0.030), activity (r=0.583, P=0.001), systemic symptoms (r=0.316, P=0.073) and preoccupation (r=0.370, P=0.034). The inspiratory muscle endurance was inversely correlated with the total quality of life score (r=0.573, P=0.001) and the following domains: fatigue (r=0.503, P=0.002), activity (r=0.464, P=0.004), systemic symptoms (r=0.472, P=0.004), abdominal symptoms (r=0.461, P=0.005), emotional function (r=0.387, P=0.02) and preoccupation (r=0.519, P=0.001). CONCLUSION Both peripheral and inspiratory muscle endurance were lower in LC patients when compared to the control group.
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Affiliation(s)
- Fabiana Coelho Couto Rocha Corrêa
- Universidade Federal de Juiz de Fora, Faculdade de Educação Física e Unidade de Investigação Cardiovascular e Fisiologia do Exercício, Juiz de Fora, MG, Brasil.,Centro Universitário Estácio Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Pedro Augusto de Carvalho Mira
- Universidade Federal de Juiz de Fora, Faculdade de Educação Física e Unidade de Investigação Cardiovascular e Fisiologia do Exercício, Juiz de Fora, MG, Brasil.,Universidade Federal Fluminense, Departamento de Fisiologia e Farmacologia, Laboratório de Ciências do Exercício, Niterói, RJ, Brasil
| | - Fábio Heleno de Lima Pace
- Universidade Federal de Juiz de Fora, Hospital Universitário, Departamento de Hepatologia e Gastroenterologia, Juiz de Fora, MG, Brasil
| | - Mateus Camaroti Laterza
- Universidade Federal de Juiz de Fora, Faculdade de Educação Física e Unidade de Investigação Cardiovascular e Fisiologia do Exercício, Juiz de Fora, MG, Brasil
| | - Patricia Fernandes Trevizan
- Universidade Federal de Juiz de Fora, Faculdade de Educação Física e Unidade de Investigação Cardiovascular e Fisiologia do Exercício, Juiz de Fora, MG, Brasil.,Centro Universitário Estácio Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Daniel Godoy Martinez
- Universidade Federal de Juiz de Fora, Faculdade de Educação Física e Unidade de Investigação Cardiovascular e Fisiologia do Exercício, Juiz de Fora, MG, Brasil
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Zhang L, Yu Y, Dong L, Gan J, Mao T, Liu T, Li X, He L. Effects of moderate exercise on hepatic amino acid and fatty acid composition, liver transcriptome, and intestinal microbiota in channel catfish (Ictalurus punctatus). COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY D-GENOMICS & PROTEOMICS 2021; 40:100921. [PMID: 34607243 DOI: 10.1016/j.cbd.2021.100921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
Previous research on swimming exercise in fish has focused on muscle building and quality of flesh. However, the effects of hepatic amino acid and fatty acid composition, liver gene expression profile, and intestinal microbiota are poorly understood. In this study, channel catfish (Ictalurus punctatus) were subjected to a 4-week swimming exercise, and liver transcriptome and intestinal microbiota analyses were performed to broaden our understanding of fish under exercise. When compared to non-exercised channel catfish (N-EXF), exercised channel catfish (EXF) had improved arachidonic acid (C20:4n6; ARA), docosahexaenoic acid (C22:6n3; DHA), aspartic acid (Asp) and glycine (Gly). The liver transcriptome analysis revealed 2912 differentially expressed genes and numerous enriched signaling pathways including those involved in nutrient synthesis, such as biosynthesis of unsaturated fatty acids and amino acids; glucose metabolism, such as glycolysis/gluconeogenesis, insulin signaling, and AMPK signaling pathways; and oxygen transport, such as HIF-1, PI3K-Akt, and MAPK signaling pathways. In addition, bacterial 16S rRNA gene sequencing data revealed that long-term exercise increased bacterial diversity and richness, and changed the intestinal microbial composition in channel catfish. In summary, this study provides insights into hepatic metabolic pathways, candidate genes, and intestinal microbiota underlying the long-term exercised channel catfish.
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Affiliation(s)
- Lang Zhang
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China.
| | - Yali Yu
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China.
| | - Lixue Dong
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Jinhua Gan
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China.
| | - Tao Mao
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China
| | - Ting Liu
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China.
| | - Xiaohui Li
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China.
| | - Li He
- Yangtze River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Wuhan, China; Key Laboratory of Control of Quality and Safety for Aquatic Products, Ministry of Agriculture and Rural Affairs, PR China.
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Hanai T, Nishimura K, Miwa T, Maeda T, Ogiso Y, Imai K, Suetsugu A, Takai K, Shimizu M. Usefulness of nutritional therapy recommended in the Japanese Society of Gastroenterology/Japan Society of Hepatology evidence-based clinical practice guidelines for liver cirrhosis 2020. J Gastroenterol 2021; 56:928-937. [PMID: 34533633 DOI: 10.1007/s00535-021-01821-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The JSGE/JSH guidelines for the management of patients with liver cirrhosis revised in 2020 recommends new strategies for nutritional assessment and intervention, although their usefulness in daily clinical practice is unclear. METHODS A total of 769 patients with cirrhosis were classified into low-, intermediate-, and high-risk groups according to hypoalbuminemia and sarcopenia, the criteria established for initiating the nutritional therapy algorithm in the guidelines. The association between these groups and mortality was analyzed using a Cox proportional hazards model. The effect of branched-chain amino acids (BCAAs) on survival was evaluated using propensity score matching. RESULTS Of the enrolled patients, 495 (64%) were men with a median age of 73 years, 428 (56%) had hypoalbuminemia, 156 (20%) had sarcopenia, and 288 (37%) were receiving BCAAs. During a median follow-up period of 1.5 years, 276 (36%) patients died. The intermediate-risk [hazard ratio (HR), 1.60; 95% confidence interval (CI), 1.18-2.18] and high-risk (HR, 2.85; 95% CI, 1.92-4.23) groups independently predicted mortality. Among the propensity score-matched 250 patients, 49 (39%) BCAA-treated and 58 (46%) untreated died. Overall survival was higher in BCAA-treated patients than in untreated patients (HR, 0.67; 95% CI, 0.46-0.98). The survival benefit of BCAAs was pronounced in the intermediate-risk (HR, 0.50; 95% CI, 0.31-0.80) and high-risk (HR, 0.38; 95% CI, 0.16-0.91) groups. CONCLUSIONS The 2020 JSGE/JSH guidelines for liver cirrhosis are useful in stratifying the mortality risk and providing effective nutritional interventions for malnourished patients with cirrhosis.
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Affiliation(s)
- Tatsunori Hanai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Kayoko Nishimura
- Center for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Japan
| | - Takao Miwa
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Toshihide Maeda
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yui Ogiso
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kenji Imai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Atsushi Suetsugu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Koji Takai
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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Biliotti E, Giampaoli O, Sciubba F, Marini F, Tomassini A, Palazzo D, Capuani G, Esvan R, Spaziante M, Taliani G, Miccheli A. Urinary metabolomics of HCV patients with severe liver fibrosis before and during the sustained virologic response achieved by direct acting antiviral treatment. Biomed Pharmacother 2021; 143:112217. [PMID: 34560544 DOI: 10.1016/j.biopha.2021.112217] [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: 05/17/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C virus (HCV) infection induces a long-term inflammatory response and oxidative-stress in the liver microenvironment, leading to hepatic fibrosis and metabolic alterations. Direct-acting-antiviral-agents (DAAs) induce HCV-clearance, even though liver damage is only partially restored. In this context, understanding the impact of viral-eradication on liver metabolic activities could allow optimizing the metabolic care of the patient. The present prospective longitudinal study aims at characterizing the urinary metabolic profile of HCV-induced severe liver fibrosis and the metabolic changes induced by DAAs and HCV-clearance by nuclear magnetic resonance-based metabolomics. The urinary metabolic profile of 23 HCV males with severe liver fibrosis and 20 age-matched healthy-controls was analyzed by NMR-based-metabolomics before starting DAAs, at the end-of-therapy, after one and three months of follow-up. The urinary metabolic profile of patients with severe liver fibrosis was associated to pseudouridine, hypoxanthine, methylguanidine and dimethylamine, highlighting a profile related to oxidative damage, and to tyrosine and glutamine, related to a decreased breakdown of aromatic aminoacids and ammonia detoxification, respectively. 1-methylnicotinamide, a catabolic intermediate of nicotinamide-adenine-dinucleotide, was significantly increased in HCV-patients and restored after HCV-clearance, probably due to the reduced hepatic inflammation. 3-hydroxy-3-methylbutyrate, an intermediate of leucine-catabolism which was permanently restored after HCV-clearance, suggested an improvement of skeletal muscle protein synthesis. Finally, 3-hydroxyisobutyrate and 2,3-dihydroxy-2-methylbutyrate, intermediates of valine-catabolism, glycine and choline increased temporarily during therapy, resulting as potential biomarkers of DAAs systemic effects.
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Affiliation(s)
- Elisa Biliotti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ottavia Giampaoli
- Department of Chemistry, Sapienza University of Rome, Rome, Italy; NMR-based Metabolomics Laboratory (NMLab), Sapienza University of Rome, Rome, Italy
| | - Fabio Sciubba
- Department of Chemistry, Sapienza University of Rome, Rome, Italy; NMR-based Metabolomics Laboratory (NMLab), Sapienza University of Rome, Rome, Italy
| | - Federico Marini
- Department of Chemistry, Sapienza University of Rome, Rome, Italy; NMR-based Metabolomics Laboratory (NMLab), Sapienza University of Rome, Rome, Italy
| | - Alberta Tomassini
- Department of Chemistry, Sapienza University of Rome, Rome, Italy; NMR-based Metabolomics Laboratory (NMLab), Sapienza University of Rome, Rome, Italy
| | - Donatella Palazzo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Capuani
- Department of Chemistry, Sapienza University of Rome, Rome, Italy; NMR-based Metabolomics Laboratory (NMLab), Sapienza University of Rome, Rome, Italy
| | - Rozenn Esvan
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Martina Spaziante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Gloria Taliani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alfredo Miccheli
- NMR-based Metabolomics Laboratory (NMLab), Sapienza University of Rome, Rome, Italy; Department of Environmental Biology, Sapienza University of Rome, Rome, Italy.
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20
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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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21
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Possible correlation between increased serum free carnitine levels and increased skeletal muscle mass following HCV eradication by direct acting antivirals. Sci Rep 2021; 11:16616. [PMID: 34400736 PMCID: PMC8368156 DOI: 10.1038/s41598-021-96203-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 12/30/2022] Open
Abstract
We aimed to evaluate factors associated with changes in skeletal muscle mass in hepatitis C virus (HCV)-infected patients after treatment with direct-acting antivirals (DAAs). Consecutive HCV-infected patients after treatment with DAA were recruited into the study. Patients who achieved sustained virological response (SVR); and had complete clinical information, preserved serum samples at baseline and SVR48, and skeletal muscle mass evaluations based on the psoas muscle mass index (PMI) on computed tomography at baseline and ≥ 12 months were included. Altogether, 70.7% of patients (41/58) showed increased PMI after DAA therapy, and mean relative PMI was significantly higher after DAA therapy than at baseline. There were no significant associations between baseline clinical factors routinely examined in clinical practice and increased PMI. Among factors reported to be associated with skeletal muscle loss in patients with chronic liver disease, serum zinc levels and total and free carnitine levels increased significantly after DAA therapy and only changes in serum free carnitine levels were significantly associated with an increased PMI (r = 0305, P = 0.020). In conclusion, increased skeletal muscle mass after successful HCV eradication by DAAs was significantly associated with increased serum-free carnitine levels. L-carnitine supplementation may be beneficial in patients with low skeletal muscle mass after DAA.
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22
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Sato S, Amano N, Sato S, Kita Y, Ikeda Y, Kabemura D, Murata A, Yatagai N, Tsuzura H, Shimada Y, Genda T. Elevated serum tyrosine concentration is associated with a poor prognosis among patients with liver cirrhosis. Hepatol Res 2021; 51:786-795. [PMID: 33964118 DOI: 10.1111/hepr.13651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022]
Abstract
AIM Chronic liver insufficiency is often associated with changes in amino acid metabolism. We evaluated whether change in serum amino acid concentrations had prognostic value among patients with liver cirrhosis. METHODS This retrospective study evaluated 158 patients who had been hospitalized with cirrhosis. Baseline serum concentrations of branched-chain amino acids (BCAAs) and tyrosine, as well as the BCAA-to-tyrosine ratio, were evaluated. Cox proportional hazards analysis was used to calculate the hazard ratios for factors that were associated with mortality or liver transplantation. RESULTS Among the 158 patients, baseline measurements showed decreased serum BCAA concentrations for 59 patients (37.3%), elevated serum tyrosine concentrations for 80 patients (50.6%), and a decreased BCAA-to-tyrosine ratio for 114 patients (72.2%). During a median follow-up period of 3.0 years, death or liver transplantation occurred at a rate of 0.136 cases/1 person-year. Multivariable analysis showed that transplant-free survival was independently predicted by older age, male sex, comorbid hepatocellular carcinoma, Child-Turcotte-Pugh score, and serum tyrosine concentration. Receiver operating characteristic curve analysis showed that a serum tyrosine concentration of >110 µmol/L was the optimal cut-off value for predicting transplant-free survival (adjusted hazard ratio 1.89, 95% confidence interval 1.15-3.11, p = 0.012). Kaplan-Meier analysis showed a significant difference in the 5-year transplant-free survival probability between patients with high and low serum tyrosine concentrations (42.1% vs. 60.7%, p < 0.001). CONCLUSIONS Elevated serum tyrosine concentration, but not changes in serum BCAA concentration or the BCAA-to-tyrosine ratio, may indicate a high risk of death or liver transplantation for patients with liver cirrhosis.
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Affiliation(s)
- Sho Sato
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Nozomi Amano
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Shunsuke Sato
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Yuji Kita
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Yuji Ikeda
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Daishi Kabemura
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Ayato Murata
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Noboru Yatagai
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hironori Tsuzura
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Yuji Shimada
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Takuya Genda
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
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23
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Saeki C, Kanai T, Nakano M, Oikawa T, Torisu Y, Saruta M, Tsubota A. Clinical characteristics of sarcopenia in patients with alcoholic liver cirrhosis. JGH OPEN 2021; 5:763-769. [PMID: 34263070 PMCID: PMC8264247 DOI: 10.1002/jgh3.12582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/20/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
Background and Aim Sarcopenia frequently develops in patient with liver cirrhosis (LC). Ethanol reduces muscle protein synthesis and accelerates proteolysis. However, the relationship between heavy alcohol consumption and sarcopenia remains controversial. This study aimed to investigate the characteristics and prevalence of sarcopenia among patients with alcoholic LC (ALC) in real‐world clinical settings. Methods This cross‐sectional study included 181 patients with LC. Heavy alcohol consumption was defined as >60 g/day. Sarcopenia was diagnosed according to the Japan Society of Hepatology criteria. Results Among the 181 patients, 64 (35.4%) were diagnosed with ALC. Patients with ALC were younger (median, 61.5 vs 72.0 years; P < 0.001) and had a lower prevalence of sarcopenia (18.8 vs 32.5%; P = 0.048) than those with non‐ALC. Conversely, the former had a higher prevalence of Child–Pugh class B/C (P = 0.015), higher total bilirubin (P = 0.017), and lower prothrombin time (P < 0.001) than the latter. The prevalence of sarcopenia increased alongside advancing age in patients with ALC (P = 0.007). Multivariate analysis identified older age (but not disease stage/liver function reserve and alcohol consumption) as an independent factor associated with sarcopenia (P = 0.002) in patients with ALC. Conclusion Patients with ALC were younger and had a lower prevalence of sarcopenia, despite advanced disease stage/impaired liver function reserve, compared to those with non‐ALC in real‐world clinical settings. However, older age was strongly associated with sarcopenia, even in patients with ALC. There was no significant influence of heavy alcohol consumption on the development of sarcopenia.
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Affiliation(s)
- Chisato Saeki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan.,Division of Gastroenterology, Department of Internal Medicine Fuji City General Hospital Shizuoka Japan
| | - Tomoya Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan.,Division of Gastroenterology, Department of Internal Medicine Fuji City General Hospital Shizuoka Japan
| | - Masanori Nakano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan.,Division of Gastroenterology, Department of Internal Medicine Fuji City General Hospital Shizuoka Japan
| | - Tsunekazu Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Yuichi Torisu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan.,Division of Gastroenterology, Department of Internal Medicine Fuji City General Hospital Shizuoka Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine The Jikei University School of Medicine Tokyo Japan
| | - Akihito Tsubota
- Core Research Facilities, Research Center for Medical Science The Jikei University School of Medicine Tokyo 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] [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 Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masaya Kato
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kaori Marui
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Taisei Murakami
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kei Onishi
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Tomoko Adachi
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Junko Matsuoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hidetaro Ueki
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Takeaki Yoshino
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Miho Tsuruta
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Toshihiko Aibiki
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Tomonari Okudaira
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Taira Kuroda
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Ryuichiro Iwasaki
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yoshifumi Suga
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hideki Miyata
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Tomoyuki Ninomiya
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Bunzo Matsuura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kojiro Michitaka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
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Nishikawa H, Fukunishi S, Asai A, Nishiguchi S, Higuchi K. Sarcopenia and Frailty in Liver Cirrhosis. Life (Basel) 2021; 11:life11050399. [PMID: 33925660 PMCID: PMC8146021 DOI: 10.3390/life11050399] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 02/06/2023] Open
Abstract
Skeletal muscle is the largest organ in the body, and skeletal muscle atrophy results from a shift in the balance of protein synthesis and degradation toward protein breakdown. Primary sarcopenia is defined as a loss of skeletal muscle mass and strength or physical function due to aging, and secondary sarcopenia is defined as a loss of skeletal muscle mass and strength or physical function due to underlying diseases. Liver cirrhosis (LC) is one of the representative diseases which can be complicated with secondary sarcopenia. Muscle mass loss becomes more pronounced with worsening liver reserve in LC patients. While frailty encompasses a state of increased vulnerability to environmental factors, there is also the reversibility of returning to a healthy state with appropriate intervention. Several assessment criteria for sarcopenia and frailty were proposed in recent years. In 2016, the Japan Society of Hepatology created assessment criteria for sarcopenia in liver disease. In Japan, health checkups for frailty in the elderly aged 75 years or more started in April 2020. Both sarcopenia and frailty can be adverse predictors for cirrhotic patients. In this review article, we will summarize the current knowledge of sarcopenia and frailty in LC patients.
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Affiliation(s)
- Hiroki Nishikawa
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan; (S.F.); (A.A.); (K.H.)
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
- Correspondence: or ; Tel.: +81-726-83-1221
| | - Shinya Fukunishi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan; (S.F.); (A.A.); (K.H.)
| | - Akira Asai
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan; (S.F.); (A.A.); (K.H.)
| | | | - Kazuhide Higuchi
- The Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan; (S.F.); (A.A.); (K.H.)
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Sarcopenic Obesity in Liver Cirrhosis: Possible Mechanism and Clinical Impact. Int J Mol Sci 2021; 22:ijms22041917. [PMID: 33671926 PMCID: PMC7919019 DOI: 10.3390/ijms22041917] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023] Open
Abstract
The picture of chronic liver diseases (CLDs) has changed considerably in recent years. One of them is the increase of non-alcoholic fatty liver disease. More and more CLD patients, even those with liver cirrhosis (LC), tend to be presenting with obesity these days. The annual rate of muscle loss increases with worsening liver reserve, and thus LC patients are more likely to complicate with sarcopenia. LC is also characterized by protein-energy malnutrition (PEM). Since the PEM in LC can be invariable, the patients probably present with sarcopenic obesity (Sa-O), which involves both sarcopenia and obesity. Currently, there is no mention of Sa-O in the guidelines; however, the rapidly increasing prevalence and poorer clinical consequences of Sa-O are recognized as an important public health problem, and the diagnostic value of Sa-O is expected to increase in the future. Sa-O involves a complex interplay of physiological mechanisms, including increased inflammatory cytokines, oxidative stress, insulin resistance, hormonal disorders, and decline of physical activity. The pathogenesis of Sa-O in LC is diverse, with a lot of perturbations in the muscle-liver-adipose tissue axis. Here, we overview the current knowledge of Sa-O, especially focusing on LC.
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Comparative study of the effect of neuromuscular electrical stimulation and oral administration of branched-chain amino acid on preventing sarcopenia in patients after living-donor liver transplantation: study protocol for an open-label randomized controlled trial. Trials 2021; 22:137. [PMID: 33579345 PMCID: PMC7881684 DOI: 10.1186/s13063-021-05086-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Liver cirrhosis is the irreversible fibrosis of the liver and causes refractory ascites and hepatic encephalopathy, which might not respond to treatment. Living donor liver transplantation (LDLT) is an effective treatment for patients with cirrhosis. However, post-LDLT patients are prone to muscle atrophy and sarcopenia. Therefore, physiotherapy of post-LDLT patients is essential for preventing the progression of sarcopenia. Recently, rehabilitation using neuromuscular electrical stimulation (NMES) has been reported to be useful for preventing the progression of sarcopenia. Similarly, nutrition therapy is essential for post-LDLT patients because these patients frequently experience malnutrition. However, the effects of combined NMES and nutrition therapy on post-LDLT patients remain unknown. Methods/design This open-label, randomized, parallel-group study will compare the effects of combined therapy with NMES and branched-chain amino acids (BCAA) with those of NMES alone in patients with decompensated cirrhosis after LDLT. After LDLT, 50 patients with decompensated cirrhosis will be randomly assigned to receive NMES with BCAA or NMES without BCAA. The duration of the intervention will be 3 months. To analyze the change in skeletal muscle mass, InBody 770 body composition and body water analysis and ultrasonography will be performed before LDLT and 4 weeks and 12 weeks post-LDLT. The primary endpoint is changes in the skeletal muscle mass from baseline to 3 months. Important secondary endpoints are the changes in the skeletal muscle mass from baseline to 1 month and changes in the quadriceps strength from baseline to 1 month. Discussion The results of this study are expected to provide evidence regarding the effect of NMES combined with BCAA therapy on the skeletal muscle of post-LDLT patients. Trial registration Japan Registry of Clinical Research jRCTs071190051. Registered on February 26, 2020.
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Zhang G, Mandal R, Wishart DS, Ametaj BN. A Multi-Platform Metabolomics Approach Identifies Urinary Metabolite Signatures That Differentiate Ketotic From Healthy Dairy Cows. Front Vet Sci 2021; 8:595983. [PMID: 33575283 PMCID: PMC7871000 DOI: 10.3389/fvets.2021.595983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
Ketosis and subclinical ketosis are widespread among dairy cows especially after calving. Etiopathology of ketosis has been related to negative energy balance. The objective of this study was to investigate metabolite fingerprints in the urine of pre-ketotic, ketotic, and post-ketotic cows to identify potential metabolite alterations that can be used in the future to identify susceptible cows for ketosis and metabolic pathways involved in the development of disease. In this study, NMR, DI/LC-MS/MS, and GC-MS-based metabolomics were used to analyze urine samples from 6 cows diagnosed with ketosis and 20 healthy control (CON) cows at -8 and -4 weeks prepartum, the week (+1 to +3) of ketosis diagnosis, and at +4 and +8 weeks after parturition. Univariate and multivariate analyses were used to screen metabolite panels that can identify cows at their pre-ketotic stage. A total of 54, 42, 48, 16, and 31 differential metabolites between the ketotic and CON cows were identified at -8 and -4 weeks prepartum, ketosis week, and at +4, and +8 weeks postpartum, respectively. Variable importance in projection (VIP) plots ranked the most significant differential metabolites, which differentiated ketotic cows from the CON ones. Additionally, several metabolic pathways that are related to ketosis were identified. Moreover, two promising metabolite panels were identified which clearly separated ketotic from CON cows with excellent level of sensitivity and specificity. Overall, multiple urinary metabolite alterations were identified in pre-ketotic, ketotic, and post-ketotic cows. The metabolite panels identified need to be validated in the future in a larger cohort of animals.
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Affiliation(s)
- Guanshi Zhang
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Rupasri Mandal
- Departments of Biological Sciences and Computing Science, University of Alberta, Edmonton, AB, Canada
| | - David S Wishart
- Departments of Biological Sciences and Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Burim N Ametaj
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
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Nogami E, Miyai N, Zhang Y, Sakaguchi M, Hayakawa H, Hattori S, Utsumi M, Uematsu Y, Arita M. [Association of Cigarette Smoking with Muscle Mass Reduction and Low Muscle Strength in Community-Dwelling Elderly Men]. Nihon Eiseigaku Zasshi 2021; 76. [PMID: 34248086 DOI: 10.1265/jjh.21003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Recently, attention has been paid to the impact of cigarette smoking on skeletal muscles, as its underlying pathophysiological mechanism has been gradually elucidated. In this study, we aimed to examine whether cigarette smoking is associated with muscle mass reduction and low muscle strength in elderly men. METHODS The study participants comprised 417 community-dwelling elderly men (aged 73±6 years) without severe glucose intolerance, chronic kidney disease, or liver disease. Bioelectrical impedance analysis was performed to estimate appendicular skeletal muscle mass (ASM), which was normalized for height (ASM index, kg/m2). Handgrip strength (HGS) was measured using a Smedley grip dynamometer. Cumulative smoking exposure level during a lifetime was expressed in pack-years, which is a product of the average number of packs of cigarettes smoked per day and smoking duration in years. RESULTS When the participants were stratified on the basis of cumulative smoking exposure (<10 pack-years, 10-39 pack-years, ≥40 pack-years), the ASM index and HGS progressively decreased with increasing exposure level (P for trend <0.01). In multiple regression analysis, heavy smoking (defined as ≥40 pack-years) was found to be a significant determinant of the ASM index and HGS, independent of potential confounding factors. Among former smokers, the subgroup that quit smoking for ≥20 years had a significantly higher ASM index and HGS than the subgroup that quit smoking for <10 years. The duration of smoking cessation was significantly associated with the ASM index and HGS, even after adjusting for cumulative smoking exposure. CONCLUSIONS These findings suggest that cigarette smoking contributes to the loss of muscle mass and function in elderly men and that smoking cessation could reverse the impact of cigarette smoking on skeletal muscles.
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Affiliation(s)
- Eriko Nogami
- Graduate School of Health and Nursing Science, Wakayama Medical University
| | - Nobuyuki Miyai
- Graduate School of Health and Nursing Science, Wakayama Medical University
| | - Yan Zhang
- Graduate School of Medicine, Wakayama Medical University
| | - Masato Sakaguchi
- Graduate School of Health and Nursing Science, Wakayama Medical University.,Sumiya Rehabilitation Hospital
| | - Hiroko Hayakawa
- Graduate School of Health and Nursing Science, Wakayama Medical University
| | - Sonomi Hattori
- Graduate School of Health and Nursing Science, Wakayama Medical University
| | - Miyoko Utsumi
- Wakayama Faculty of Nursing, Tokyo Healthcare University
| | - Yuji Uematsu
- Graduate School of Health and Nursing Science, Wakayama Medical University
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Kumar U, Sharma S, Durgappa M, Gupta N, Raj R, Kumar A, Sharma PN, Krishna VP, Kumar RV, Guleria A, Saraswat VA, Pande G, Kumar D. Serum Metabolic Disturbances Associated with Acute-on-chronic Liver Failure in Patients with Underlying Alcoholic Liver Diseases: An Elaborative NMR-based Metabolomics Study. J Pharm Bioallied Sci 2020; 13:276-282. [PMID: 34349490 PMCID: PMC8291109 DOI: 10.4103/jpbs.jpbs_333_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/03/2020] [Accepted: 06/18/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives: Acute-on-chronic liver failure (ACLF), which develops in patients with underlying alcoholic liver disease (ALD), is characterized by acute deterioration of liver function and organ failures are secondary to that. The clear understanding of metabolic pathways perturbed in ALD-ACLF patients can greatly decrease the mortality and morbidity of patients through predicting outcome, guiding treatment, and monitoring response to treatment. The purpose of this study was to investigate the metabolic disturbances associated with ACLF using nuclear magnetic resonance (NMR)-based serum metabolomics approach and further to assess if the serum metabolic alterations are affected by the severity of hepatic impairment. Materials and Methods: The serum-metabolic profiles of 40 ALD-ACLF patients were compared to those of 49 age and sex-matched normal-control (NC) subjects making composite use of both multivariate and univariate statistical tests. Results: Compared to NC, the sera of ACLF patients were characterized by significantly decreased serum levels of several amino acids (except methionine and tyrosine), lipid, and membrane metabolites suggesting a kind of nutritional deficiency and disturbed metabolic homeostasis in ACLF. Twelve serum metabolic entities (including BCAA, histidine, alanine, threonine, and glutamine) were found with AUROC (i.e., area under ROC curve) value >0.9 suggesting their potential in clinical diagnosis and surveillance. Conclusion: Overall, the study revealed important metabolic changes underlying the pathophysiology of ACLF and those related to disease progression would add value to standard clinical scores of severity to predict outcome and may serve as surrogate endpoints for evaluating treatment response.
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Affiliation(s)
- Umesh Kumar
- Centre of Biomedical Research (CBMR), Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.,Department of Zoology, Babasaheb Bhimrao Ambedkar University (BBAU), Lucknow, Uttar Pradesh, India
| | - Supriya Sharma
- Department of Gastrosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Manjunath Durgappa
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Nikhil Gupta
- Centre of Biomedical Research (CBMR), Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Ritu Raj
- Centre of Biomedical Research (CBMR), Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Alok Kumar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prabhat N Sharma
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - V P Krishna
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - R Venkatesh Kumar
- Department of Gastrosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Anupam Guleria
- Centre of Biomedical Research (CBMR), Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Vivek A Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Gaurav Pande
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Dinesh Kumar
- Centre of Biomedical Research (CBMR), Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
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Low Serum Branched-Chain Amino Acid and Insulin-Like Growth Factor-1 Levels Are Associated with Sarcopenia and Slow Gait Speed in Patients with Liver Cirrhosis. J Clin Med 2020; 9:jcm9103239. [PMID: 33050430 PMCID: PMC7600046 DOI: 10.3390/jcm9103239] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022] Open
Abstract
Branched-chain amino acid (BCAA) and insulin-like growth factor 1 (IGF-1) are essential for muscle protein synthesis. We investigated the association of serum BCAA and IGF-1 levels with sarcopenia and gait speed in 192 patients with liver cirrhosis (LC). Sarcopenia was diagnosed according to the Japan Society of Hepatology criteria. Slow gait speed was defined as <1.0 m/s. Subjects were divided into three groups based on baseline BCAA or IGF-1 levels: low (L), intermediate (I), and high (H) groups. The L-BCAA group had the highest prevalence of sarcopenia (60.4%, p < 0.001) and slow gait speed (56.3%, p = 0.008), whereas the H-BCAA group had the lowest prevalence of sarcopenia (8.5%, p < 0.001). The L-IGF-1 group showed the highest prevalence of sarcopenia (46.9%, p < 0.001), whereas the H-IGF-1 group had the lowest prevalence of sarcopenia (10.0%, p < 0.001) and slow gait speed (18.0%, p = 0.003). Using the optimal BCAA and IGF-1 cutoff values for predicting sarcopenia (372 μmol/L and 48.5 ng/mL, respectively), the sensitivity and specificity were 0.709 and 0.759 for BCAA and 0.636 and 0.715 for IGF-1, respectively. Low serum BCAA and IGF-1 levels were associated with sarcopenia and slow gait speed in patients with LC.
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Saeki C, Kanai T, Nakano M, Oikawa T, Torisu Y, Abo M, Saruta M, Tsubota A. Relationship between Osteosarcopenia and Frailty in Patients with Chronic Liver Disease. J Clin Med 2020; 9:jcm9082381. [PMID: 32722566 PMCID: PMC7465351 DOI: 10.3390/jcm9082381] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 12/22/2022] Open
Abstract
Osteosarcopenia and frailty have a negative health impact on an aging society. This cross-sectional study aimed to investigate the clinical characteristics and relationship of osteosarcopenia and frailty in 291 patients with chronic liver disease (CLD), who comprised 137 males and 154 females, with a median age of 70.0 years. Sarcopenia was diagnosed according to the Japan Society of Hepatology criteria. Bone mineral density was measured using dual-energy X-ray absorptiometry. Frailty was defined by five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). Among the 291 patients, 49 (16.8%) and 81 (27.8%) had osteosarcopenia and frailty, respectively. Frailty and vertebral fracture were more frequently noted in patients with osteosarcopenia than in those without osteosarcopenia (79.6% vs. 17.4% and 59.2% vs. 20.2%, respectively; p < 0.001 for both). Meanwhile, osteosarcopenia and vertebral fracture were more frequently observed in patients with frailty than in those without frailty (48.1% vs. 4.8% and 49.4% vs. 18.1%, respectively; p < 0.001 for both). On multivariate analysis, frailty was an independent factor associated with osteosarcopenia (odds ratio (OR), 9.837; p < 0.001), and vice versa (OR, 10.069; p < 0.001). Osteosarcopenia and frailty were prevalent, closely interrelated, and increased the risk of vertebral fracture in patients with CLD.
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Affiliation(s)
- Chisato Saeki
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan; (T.K.); (M.N.); (T.O.); (Y.T.); (M.S.)
- Department of Internal Medicine, Division of Gastroenterology, Fuji City General Hospital, 50 Takashima-cho, Fuji-shi, Shizuoka 417-8567, Japan
- Correspondence: (C.S.); (A.T.); Tel.: +81-3-3433-1111(C.S. & A.T.)
| | - Tomoya Kanai
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan; (T.K.); (M.N.); (T.O.); (Y.T.); (M.S.)
- Department of Internal Medicine, Division of Gastroenterology, Fuji City General Hospital, 50 Takashima-cho, Fuji-shi, Shizuoka 417-8567, Japan
| | - Masanori Nakano
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan; (T.K.); (M.N.); (T.O.); (Y.T.); (M.S.)
- Department of Internal Medicine, Division of Gastroenterology, Fuji City General Hospital, 50 Takashima-cho, Fuji-shi, Shizuoka 417-8567, Japan
| | - Tsunekazu Oikawa
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan; (T.K.); (M.N.); (T.O.); (Y.T.); (M.S.)
| | - Yuichi Torisu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan; (T.K.); (M.N.); (T.O.); (Y.T.); (M.S.)
- Department of Internal Medicine, Division of Gastroenterology, Fuji City General Hospital, 50 Takashima-cho, Fuji-shi, Shizuoka 417-8567, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan;
| | - Masayuki Saruta
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan; (T.K.); (M.N.); (T.O.); (Y.T.); (M.S.)
| | - Akihito Tsubota
- Core Research Facilities, Research Center for Medical Science, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan
- Correspondence: (C.S.); (A.T.); Tel.: +81-3-3433-1111(C.S. & A.T.)
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NUTRIC and Modified NUTRIC are Accurate Predictors of Outcome in End-Stage Liver Disease: A Validation in Critically Ill Patients with Liver Cirrhosis. Nutrients 2020; 12:nu12072134. [PMID: 32709104 PMCID: PMC7400844 DOI: 10.3390/nu12072134] [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: 06/04/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Malnutrition in critically ill patients with cirrhosis is a frequent but often overlooked complication with high prognostic relevance. The Nutrition Risk in Critically ill (NUTRIC) score and its modified variant (mNUTRIC) were established to assess the nutrition risk of intensive care unit patients. Considering the high mortality of cirrhosis in critically ill patients, this study aims to evaluate the discriminative ability of NUTRIC and mNUTRIC to predict outcome. We performed a retro-prospective evaluation in 150 Caucasian cirrhotic patients admitted to our ICU. Comparative prognostic analyses between NUTRIC and mNUTRIC were assessed in 114 patients. On ICU admission, a large proportion of 65% were classified as high NUTRIC (6-10) and 75% were categorized as high mNUTRIC (5-9). High nutritional risk was linked to disease severity and poor outcome. NUTRIC was moderately superior to mNUTRIC in prediction of 28-day mortality (area under curve 0.806 vs. 0.788) as well as 3-month mortality (area under curve 0.839 vs. 0.819). We found a significant association of NUTRIC and mNUTRIC with MELD, CHILD, renal function, interleukin 6 and albumin, but not with body mass index. NUTRIC and mNUTRIC are characterized by high prognostic accuracy in critically ill patients with cirrhosis. NUTRIC revealed a moderate advantage in prognostic ability compared to mNUTRIC.
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Hanai T, Shiraki M, Imai K, Suetugu A, Takai K, Shimizu M. Usefulness of Carnitine Supplementation for the Complications of Liver Cirrhosis. Nutrients 2020; 12:nu12071915. [PMID: 32610446 PMCID: PMC7401279 DOI: 10.3390/nu12071915] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Carnitine is a vitamin-like substance that regulates lipid metabolism and energy production. Carnitine homeostasis is mainly regulated by dietary intake and biosynthesis in the organs, including the skeletal muscle and the liver. Therefore, liver cirrhotic patients with reduced food intake, malnutrition, biosynthetic disorder, and poor storage capacity of carnitine in the skeletal muscle and liver are more likely to experience carnitine deficiency. In particular, liver cirrhotic patients with sarcopenia are at a high risk for developing carnitine deficiency. Carnitine deficiency impairs the important metabolic processes of the liver, such as gluconeogenesis, fatty acid metabolism, albumin biosynthesis, and ammonia detoxification by the urea cycle, and causes hypoalbuminemia and hyperammonemia. Carnitine deficiency should be suspected in liver cirrhotic patients with severe malaise, hepatic encephalopathy, sarcopenia, muscle cramps, and so on. Importantly, the blood carnitine level does not always decrease in patients with liver cirrhosis, and it sometimes exceeds the normal level. Therefore, patients with liver cirrhosis should be treated as if they are in a state of relative carnitine deficiency at the liver, skeletal muscle, and mitochondrial levels, even if the blood carnitine level is not decreased. Recent clinical trials have revealed the effectiveness of carnitine supplementation for the complications of liver cirrhosis, such as hepatic encephalopathy, sarcopenia, and muscle cramps. In conclusion, carnitine deficiency is not always rare in liver cirrhosis, and it requires constant attention in the daily medical care of this disease. Carnitine supplementation might be an important strategy for improving the quality of life of patients with liver cirrhosis.
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Affiliation(s)
- Tatsunori Hanai
- Correspondence: ; Tel.: +81-(58)-230-6308; Fax: +81-(58)-230-6310
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Ohara M, Suda G, Kimura M, Maehara O, Shimazaki T, Shigesawa T, Suzuki K, Nakamura A, Kawagishi N, Nakai M, Sho T, Natsuizaka M, Morikawa K, Ogawa K, Kobayashi T, Uebayashi M, Takagi R, Yokota I, Shimamura T, Sakamoto N. Analysis of the optimal psoas muscle mass index cut-off values, as measured by computed tomography, for the diagnosis of loss of skeletal muscle mass in Japanese people. Hepatol Res 2020; 50:715-725. [PMID: 32202371 DOI: 10.1111/hepr.13499] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/02/2020] [Accepted: 03/18/2020] [Indexed: 12/20/2022]
Abstract
UNLABELLED This study aimed to determine the optimal psoas muscle mass index (PMI) cut-off values for diagnosis of skeletal muscle mass loss. METHODS We evaluated PMI in two groups of normal controls: a medical check-up group and a liver donation candidate group. We analyzed two novel PMI cut-off values, one based on the mean - two standard deviations (2SD) and one based on the lower 5%. Skeletal muscle mass index (SMI) evaluations using computed tomography (sliceOmatic; TomoVision) and bioelectrical impedance analysis and PMI evaluation were undertaken simultaneously. We analyzed the correlation between our PMI cut-off values and the Japan Society of Hepatology-defined SMI cut-off values. The prevalence of skeletal muscle mass loss in patients with liver disease was assessed using the novel PMI cut-off values. RESULTS In 504 normal controls aged ≤50 years, the PMI cut-off values based on mean -2SD and the lower 5% were set at 3.30 cm2 /m2 for men and 1.69 cm2 /m2 for women and 3.74 cm2 /m2 for men and 2.29 cm2 /m2 for women, respectively. The PMI cut-off values based on the lower 5% alone showed that skeletal muscle mass loss increased with age. Furthermore, they correlated well with Japan Society of Hepatology-defined SMI (sliceOmatic) cut-off values and showed a significantly higher prevalence of skeletal muscle mass loss in patients with liver cirrhosis than those without liver cirrhosis. CONCLUSIONS We propose the following PMI cut-off values: 3.74 cm2 /m2 for male individuals and 2.29 cm2 /m2 for female individuals. These cut-off values can facilitate accurate diagnosis and management of sarcopenia in patients with chronic liver disease.
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Affiliation(s)
- Masatsugu Ohara
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Goki Suda
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Megumi Kimura
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Osamu Maehara
- Department of Pathophysiology and Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoe Shimazaki
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Taku Shigesawa
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuharu Suzuki
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akihisa Nakamura
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoki Kawagishi
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masato Nakai
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takuya Sho
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mitsuteru Natsuizaka
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenichi Morikawa
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koji Ogawa
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomoe Kobayashi
- Department of Gastroenterology and Hepatology, Tomakomai City Hospital, Hokkaido, Japan
| | - Minoru Uebayashi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Kitami Hospital, Hokkaido, Japan
| | - Ryo Takagi
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsuyoshi Shimamura
- Division of Organ Transplantation, Hokkaido University Hospital, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Xu H, Ruan LY, Chen C, Fan JT, Chen JF, Zhao WL, Meng HH, Liu WY, Zhao WL, Zheng Q, Liu ZC, Wang JS. Therapeutic assessment of fractions of Gastrodiae Rhizoma on chronic atrophic gastritis by 1H NMR-based metabolomics. JOURNAL OF ETHNOPHARMACOLOGY 2020; 254:112403. [PMID: 32109546 DOI: 10.1016/j.jep.2019.112403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Gastrodiae Rhizoma (GR), a well-known and commonly-used TCM (Traditional Chinese Medicine) for treating headache, dizziness, tetanus, epilepsy, and etc., has been proven to relieve chronic atrophic gastritis (CAG). Due to its complex ingredients, the active fractions responsible for the treatment of CAG remain largely unknown. AIM OF THE STUDY To explore the underlying material and interpret its underlying mechanism, the therapeutic effect of extract from different polar parts of Gastrodiae Rhizoma on autoimmune CAG was studied based on the 1H NMR metabolomics. MATERIALS AND METHODS The rat model of CAG was established by autoimmune method. The modeled CAG rats were then treated with 4 polar parts (T1-4 in descending polarity, corresponding to water, n-butanol, ethyl acetate and petroleum ether extracts, respectively) of Gastrodiae Rhizoma for 21 consecutive days. The stomach and serum samples were collected and then subjected to histopathology observation, biochemical measurement (MDA, SOD, GSH, NO, XOD and pepsin), 1H NMR metabolic profiling and multivariate/univariate statistical analysis. RESULTS The results showed that T1 had the best therapeutic effect, T2 the second, and T3 and T4 the poorest with no obvious therapeutic effect, demonstrating that the effective components of Gastrodiae Rhizoma should be compounds of high polarity. T1 achieved good therapeutic effects due to the anti-inflammatory and anti-oxidant activities, and by rectifying the disturbed energy and amino acid metabolism in CAG model. CONCLUSION This integrated metabolomics approach proved the validity of the therapeutic effect of extract from different polar parts of Gastrodiae Rhizoma on autoimmune CAG, providing new insights into the underlying mechanisms, and demonstrating the feasibility of metabolomics to evaluate efficacy of herbal drug, which is often difficult by traditional means.
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Affiliation(s)
- Han Xu
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Ling-Yu Ruan
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Cheng Chen
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Jun-Ting Fan
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
| | - Jian-Feng Chen
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Wen-Long Zhao
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Hui-Hui Meng
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Wen-Ya Liu
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Wen-Li Zhao
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Qi Zheng
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Zhi-Chao Liu
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China
| | - Jun-Song Wang
- Center of Molecular Metabolism, Nanjing University of Science and Technology, 200 Xiaolingwei Street, Nanjing, 210094, China.
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Abstract
Research increasingly shows that the gut-liver-brain axis is a crucial component in the pathophysiology of hepatic encephalopathy (HE). Due to the limitations of current standard-of-care medications, non-pharmacological treatments that target gut dysbiosis, including probiotics, nutritional management, and fecal microbiota transplants, are being considered as alternative and adjunct therapies. Meta-analyses note that probiotics could offer benefits in HE treatment, but have not shown superiority over lactulose. Emerging literature suggests that fecal microbiota transplants could offer a novel strategy to treat gut dysbiosis and favorably impact HE. Finally, liver support devices and liver transplantation could offer a last-resort treatment option for persistent HE.
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Affiliation(s)
- Vanessa Weir
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, 7 South Pavilion, 3400 Civic Center Boulevard, HUP, Philadelphia, PA 19104, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA 19104, USA.
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38
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Bellar A, Welch N, Dasarathy S. Exercise and physical activity in cirrhosis: opportunities or perils. J Appl Physiol (1985) 2020; 128:1547-1567. [PMID: 32240017 DOI: 10.1152/japplphysiol.00798.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Reduced exercise capacity and impaired physical performance are observed in nearly all patients with liver cirrhosis. Physical activity and exercise are physiological anabolic stimuli that can reverse dysregulated protein homeostasis or proteostasis and potentially increase muscle mass and contractile function in healthy subjects. Cirrhosis is a state of anabolic resistance, and unlike the beneficial responses to exercise reported in physiological states, there are few systematic studies evaluating the response to exercise in cirrhosis. Hyperammonemia is a mediator of the liver-muscle axis with net skeletal muscle ammonia uptake in cirrhosis causing signaling perturbations, mitochondrial dysfunction with decreased ATP content, modifications of contractile proteins, and impaired ribosomal function, all of which contribute to anabolic resistance in cirrhosis and have the potential to impair the beneficial responses to exercise. English language-publications in peer-reviewed journals that specifically evaluated the impact of exercise in cirrhosis were reviewed. Most studies evaluated responses to endurance exercise, and readouts included peak or maximum oxygen utilization, grip strength, and functional capacity. Endurance exercise for up to 12 wk is clinically tolerated in well-compensated cirrhosis. Data on the safety of resistance exercise are conflicting. Nutritional supplements enhance the benefits of exercise in healthy subjects but have not been evaluated in cirrhosis. Whether the beneficial physiological responses with endurance exercise and increase in muscle mass with resistance exercise that occur in healthy subjects also occur in cirrhotics is not known. Specific organ-system responses, changes in body composition, or improved long-term clinical outcomes with exercise in cirrhosis need evaluation.
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Affiliation(s)
- Annette Bellar
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicole Welch
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Gastroenterology, Hepatology Cleveland Clinic, Cleveland, Ohio
| | - Srinivasan Dasarathy
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Gastroenterology, Hepatology Cleveland Clinic, Cleveland, Ohio
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39
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Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7170457. [PMID: 32280697 PMCID: PMC7114768 DOI: 10.1155/2020/7170457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/12/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.
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40
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Ujiie N, Nakano T, Yamada M, Sato C, Nakanishi C, Fujishima F, Ito K, Shindo T, Shimokawa H, Kamei T. Low-energy extracorporeal shock wave therapy for a model of liver cirrhosis ameliorates liver fibrosis and liver function. Sci Rep 2020; 10:2405. [PMID: 32051434 PMCID: PMC7016168 DOI: 10.1038/s41598-020-58369-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/06/2020] [Indexed: 12/02/2022] Open
Abstract
Low-energy extracorporeal shock waves (LESW) have been studied as a new treatment for angina pectoris and several ischemic diseases because of its effect on angiogenesis and inhibition of fibrosis of the heart. The effect of LESW on fibrosis in liver cirrhosis has not been studied. The aim of this study was to verify the amelioration of liver fibrosis by LESW and elucidate its mechanisms in a rat model of drug-induced liver cirrhosis. Male Wistar rats aged 7 weeks were injected with carbon tetrachloride intraperitoneally twice a week for 12 weeks. Eight rats underwent LESW therapy (0.25 mJ/mm2, 4 Hz, 1000 shots) under general anesthesia (shock wave group). Seven rats only underwent general anesthesia (control group). Quantitative analysis showed that the area of fibrosis in the shock wave group was significantly reduced compared with the control group (11,899.9 vs. 23,525.3 pixels per field, p < 0.001). In the shock wave group, the mRNA expression of transforming growth factor (TGF)-β1 was significantly suppressed (0.40-fold, p = 0.018) and vascular endothelial growth factor-B was significantly increased (1.77-fold, p = 0.006) compared with the control group. Serum albumin was significantly higher in the shock wave group than in the control group (3.0 vs. 2.4 g/dl, p = 0.025). Aspartate aminotransferase/alanine aminotransferase ratio decreased by LESW compared with the control group (1.49 vs. 2.04, p = 0.013). These results suggest that LESW therapy ameliorates liver fibrosis by reducing the expression of TGF-β1 and increasing the expression of angiogenic factors, and improves hepatic function.
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Affiliation(s)
- Naoto Ujiie
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toru Nakano
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. .,Division of Gastroenterologic and Hepatobiliarypancreatic Surgery, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi, Japan.
| | - Masato Yamada
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Chiaki Sato
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fumiyoshi Fujishima
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenta Ito
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kamei
- Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Amano N, Ikeda Y, Hayashida S, Takahashi S, Sato S, Murata A, Tsuzura H, Sato S, Shimada Y, Iijima K, Wada R, Nagahara A, Genda T. Prognostic significance of serum tyrosine concentration in patients with primary biliary cholangitis under ursodeoxycholic acid therapy. Hepatol Res 2020; 50:214-223. [PMID: 31652380 DOI: 10.1111/hepr.13434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023]
Abstract
AIM Chronic liver insufficiency is often associated with alteration in amino acid metabolism. We evaluated the prognostic value of changes in serum amino acid concentrations in patients with primary biliary cholangitis. METHODS A total of 75 primary biliary cholangitis patients who started urusodeoxycholic acid therapy were retrospectively enrolled. Baseline serum concentrations of branched-chain amino acids and tyrosine, and branched-chain amino acid-to-tyrosine ratio were determined. The hazard ratios of factors associated with liver-related events were analyzed by Cox proportional hazard analysis. RESULTS Of the 75 patients enrolled, 12 showed a decrease in serum branched-chain amino acid levels, and 15 showed an increase in serum tyrosine levels. The branched-chain amino acid-to-tyrosine ratio decreased in 16 patients. During a median 5.6-year follow up, liver-related events occurred in 11 patients. Multivariate analysis showed that high serum tyrosine levels at baseline and high alkaline phosphatase levels 48 weeks after starting urusodeoxycholic acid therapy were independent risk factors for event occurrence. From the receiver operator characteristics curve analysis, serum tyrosine concentration >110 μmol/L was identified as a cut-off value with an adjusted hazard ratio of 20.9 (95% confidence interval 4.3-101.5, P < 0.001). Kaplan-Meier analysis showed that the 5-year cumulative incidences of event occurrence in patients with high and low serum tyrosine concentration were 56.5% and 5.5%, respectively (P < 0.001). The 10-year survival probabilities also showed significant differences between patients with high and low serum tyrosine concentration (44.9% vs. 92.0%, P < 0.001). CONCLUSION Elevation of serum tyrosine concentration indicates a high risk of liver-related events in primary biliary cholangitis patients receiving urusodeoxycholic acid therapy.
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Affiliation(s)
- Nozomi Amano
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Yuji Ikeda
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Sho Hayashida
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Sho Takahashi
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Sho Sato
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Ayato Murata
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Hironori Tsuzura
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Shunsuke Sato
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Yuji Shimada
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Katsuyori Iijima
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Ryo Wada
- Department of Pathology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takuya Genda
- Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
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Nishikawa H, Takata R, Enomoto H, Yoh K, Iwata Y, Sakai Y, Kishino K, Shimono Y, Ikeda N, Takashima T, Aizawa N, Hasegawa K, Ishii N, Yuri Y, Nishimura T, Iijima H, Nishiguchi S. Serum Zinc Level and non-Protein Respiratory Quotient in Patients with Chronic Liver Diseases. J Clin Med 2020; 9:jcm9010255. [PMID: 31963540 PMCID: PMC7019764 DOI: 10.3390/jcm9010255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022] Open
Abstract
We sought to clarify the correlation between non-protein respiratory quotient (npRQ) in indirect calorimetry and serum zinc (Zn) level in chronic liver diseases (CLDs, n = 586, 309 liver cirrhosis (LC) patients, median age = 63 years). Clinical parameters potentially linked to npRQ <0.85 (best cutoff point for the prognosis in LC patients) were also examined in receiver operating characteristic curve (ROC) analyses. The median npRQ was 0.86. The median serum Zn level was 64 μg/dL. The median npRQ in patients with non-LC, Child–Pugh A, Child–Pugh B and Child–Pugh C were 0.89, 0.85, 0.83 and 0.82 (overall p < 0.0001)). The median serum Zn level in patients with npRQ <0.85 (58 μg/dL) was significantly lower than that in patients with npRQ ≥ 0.85 (68 μg/dL) (p < 0.0001). The correlation coefficient (r) between npRQ level and serum Zn level for all cases was 0.40 (p < 0.0001). Similar tendencies were observed in all subgroup analyses. The highest correlation coefficient between serum Zn level and npRQ was found in patients with Child–Pugh C (n = 22, r = 0.69). In ROC analyses for npRQ <0.85, serum Zn level had the highest area under the ROC (AUC) among baseline laboratory parameters (AUC = 0.69). In conclusion, serum Zn level can be helpful for npRQ in patients with CLDs.
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Saeki C, Takano K, Oikawa T, Aoki Y, Kanai T, Takakura K, Nakano M, Torisu Y, Sasaki N, Abo M, Matsuura T, Tsubota A, Saruta M. Comparative assessment of sarcopenia using the JSH, AWGS, and EWGSOP2 criteria and the relationship between sarcopenia, osteoporosis, and osteosarcopenia in patients with liver cirrhosis. BMC Musculoskelet Disord 2019; 20:615. [PMID: 31878909 PMCID: PMC6933666 DOI: 10.1186/s12891-019-2983-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sarcopenia and osteoporosis reduce life quality and worsen prognosis in patients with liver cirrhosis (LC). When these two complications coexist, a diagnosis of osteosarcopenia is made. We aimed to investigate the actual situations of sarcopenia, osteoporosis, osteosarcopenia, and vertebral fracture, and to clarify the relationship among these events in patients with LC. METHODS We describe a cross-sectional study of 142 patients with LC. Sarcopenia was defined according to the Japan Society of Hepatology (JSH) criteria, Asian Working Group for Sarcopenia (AWGS) criteria, and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. The skeletal muscle mass index (SMI) and handgrip strength were assessed using bioelectrical impedance analysis and a digital grip strength dynamometer, respectively. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry, and vertebral fracture was evaluated using spinal lateral X-rays. The severity of LC was assessed using the Child-Pugh classification. RESULTS Among the 142 patients, the prevalence of sarcopenia was 33.8% (48/142) according to the JSH and AWGS criteria and 28.2% (40/142) according to the EWGSOP2 criteria. The number of patients with osteoporosis, osteosarcopenia, and vertebral fracture was 49 (34.5%), 31 (21.8%), and 41 (28.9%), respectively. Multivariate analysis revealed a close association between sarcopenia and osteoporosis. Osteoporosis was independently associated with sarcopenia [odds ratio (OR) = 3.923, P = 0.010]. Conversely, sarcopenia was independently associated with osteoporosis (OR = 5.722, P < 0.001). Vertebral fracture occurred most frequently in patients with osteosarcopenia (19/31; 61.3%) and least frequently in those without both sarcopenia and osteoporosis (12/76; 15.8%). The SMI and handgrip strength values were significantly correlated with the BMD of the lumbar spine (r = 0.55 and 0.51, respectively; P < 0.001 for both), femoral neck, (r = 0.67 and 0.62, respectively; P < 0.001 for both), and total hip (r = 0.67 and 0.61, respectively; P < 0.001 for both). CONCLUSIONS Sarcopenia, osteoporosis, osteosarcopenia, and vertebral fracture were highly prevalent and closely associated with one another in patients with LC. Specifically, patients with osteosarcopenia had the highest risk of vertebral fractures. Early diagnosis of these complications is essential for treatment intervention.
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Affiliation(s)
- Chisato Saeki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan. .,Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Shizuoka, Japan.
| | - Keiko Takano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tsunekazu Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yuma Aoki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Shizuoka, Japan
| | - Tomoya Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Shizuoka, Japan
| | - Kazuki Takakura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masanori Nakano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Shizuoka, Japan
| | - Yuichi Torisu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.,Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Shizuoka, Japan
| | - Nobuyuki Sasaki
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomokazu Matsuura
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihito Tsubota
- Core Research Facilities, Research Center for Medical Science, The Jikei University School of Medicine, Tokyo, Japan.
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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44
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Fallahzadeh MA, Rahimi RS. Hepatic Encephalopathy and Nutrition Influences: A Narrative Review. Nutr Clin Pract 2019; 35:36-48. [PMID: 31872484 DOI: 10.1002/ncp.10458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Hepatic encephalopathy (HE) is a potentially reversible neurocognitive condition seen in patients with advanced liver disease. The overt form of HE has been reported in up to 45% of patients with cirrhosis. This debilitating condition is associated with increased morbidity and mortality and imposes a significant burden on the caregivers and healthcare system. After providing an overview of HE epidemiology and pathophysiology, this review focuses on the interaction of HE and frailty, nutrition requirements and recommendations in cirrhotic patients with HE, and current dietary and pharmacologic options for HE treatment.
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Affiliation(s)
- Mohammad Amin Fallahzadeh
- Division of Hepatology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
| | - Robert S Rahimi
- Division of Hepatology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
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45
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Ashikawa H, Adachi T, Ueyama J, Yamada S. Association between redox state of human serum albumin and exercise capacity in older women: A cross-sectional study. Geriatr Gerontol Int 2019; 20:256-260. [PMID: 31854142 DOI: 10.1111/ggi.13849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/17/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022]
Abstract
AIM Oxidative stress plays a key role in declining exercise capacity, which is one of the major health problems in old age. The redox state of human serum albumin (HSA) has been considered a biomarker reflecting oxidative stress; however, its relationship to exercise capacity in older people remains to be examined. We aimed to examine the redox state of HSA as a potential biomarker of exercise capacity in community-dwelling older women. METHODS We analyzed 125 women aged ≥75 years. Exercise capacity was evaluated using 6-min walk distance (6MWD). The redox state of HSA was analyzed using the high-performance liquid chromatography post-column bromocresol green reaction method. The fraction of human mercaptalbumin in HSA (f[HMA]) was considered the redox state of HSA. Pearson's correlation coefficient (r) or Spearman's correlation coefficient (ρ) was used to assess correlations between 6MWD, f(HMA) and HSA. The association between 6MWD and f(HMA) was further examined using multivariate linear regression analysis adjusted for age, diabetes mellitus, renal function, number of medications, HSA and knee extensor isometric strength. RESULTS The 6MWD was significantly correlated with f(HMA; ρ = 0.44, P < 0.001), but not with HSA (r = 0.05, P = 0.562). The f(HMA) was not significantly correlated with HSA (ρ = 0.03, P = 0.769). Multivariate linear regression analysis showed that f(HMA) was independently associated with 6MWD (standardized β = 0.27, P = 0.004). CONCLUSIONS The findings of this study suggest that f(HMA) might serve as a novel biomarker for exercise capacity in community-dwelling older women. Geriatr Gerontol Int 2019; ••: ••-••.
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Affiliation(s)
- Hironobu Ashikawa
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuji Adachi
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun Ueyama
- Department of Pathophysiological Laboratory Sciences, Field of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sumio Yamada
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
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46
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Association between Albumin-Bilirubin Grade and Non-Protein Respiratory Quotient in Patients with Chronic Liver Diseases. J Clin Med 2019; 8:jcm8091485. [PMID: 31540447 PMCID: PMC6780903 DOI: 10.3390/jcm8091485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 02/08/2023] Open
Abstract
We sought to elucidate the relationship between albumin-bilirubin (ALBI) grade and non-protein respiratory quotient (npRQ) calculated by indirect calorimetry in chronic liver disease (CLD) patients (n = 601, median age = 63 years). Factors linked to npRQ < 0.85, which is reported to be an optimal cutoff point for the prognosis in liver cirrhosis (LC) patients, were also investigated using univariate and multivariate analyses. The median npRQ for all cases was 0.86. In total, 253 patients (42.1%) had npRQ < 0.85. The proportions of patients with npRQ < 0.85 in LC and non-LC patients were 51.9% (166/320) in LC patients and 31.0% (87/281) in non-LC patients (p < 0.0001). The median npRQ in ALBI grades 1, 2, and 3 for all cases were: 0.89, 0.85, and 0.82 (overall p < 0.0001). The proportions of patients with npRQ < 0.85 were 31.0% (71/229) in ALBI grade 1, 46.34% (152/328) in ALBI grade 2, and 68.18% (30/44) in ALBI grade 3 (overall p < 0.0001). In multivariate analyses of factors linked to npRQ < 0.85, ALBI grade 3 (p = 0.0095, hazard ratio = 3.242, ALBI grade 1 as a reference) was an independent predictor along with prothrombin time (p = 0.0139). In conclusion, ALBI grade can be a useful marker for npRQ in patients with CLDs.
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Lee M, Kim K. Innovative and practical conditioning beverages for public health and athletic performance: Focus on immunopotentiation by lactic acid bacteria B240. J Exerc Nutrition Biochem 2019; 23:13-15. [PMID: 31337200 PMCID: PMC6651673 DOI: 10.20463/jenb.2019.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/01/2022] Open
Abstract
[Purpose] Functional beverages are a protective or enhancing factor influencing not only public health but also athletic performance. The purpose of this study was to highlight the new conditioning beverage of the Lactobacillus pentosus strain b240 (B240) with electrolytes or proteins, which strengthens immune functions to improve the quality of life. [Methods] ISeveral related studies systematically reviews three main issues associated with conditioning beverages: (a) utilization and availability of the functional beverage; (b) significance of B240 in immune strengthening; and (c) availability and application of conditioning drinks in the daily life and sports field. [Results] Intake of B240 led to greater enhancements, including blood T-helper, NK cell, IgA and IgG level in conjunction with strengthen immune func¬tions. These results speculated that the practical application of B240 contained beverages on physiological health and performance. [Conclusion] BODYMAINTÉ, this novel conditioning beverage is expected biological utility responsible for improved sports performance as a functional drink and has potential health-related implications.
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Zhu Y, Ni T, Lin J, Zhang C, Zheng L, Luo M. Long non-coding RNA H19, a negative regulator of microRNA-148b-3p, participates in hypoxia stress in human hepatic sinusoidal endothelial cells via NOX4 and eNOS/NO signaling. Biochimie 2019; 163:128-136. [PMID: 31082428 DOI: 10.1016/j.biochi.2019.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/04/2019] [Indexed: 01/20/2023]
Abstract
This study aimed at the participation of lncRNA H19, endothelial NADPH oxidases (NOX4) and miR-148b-3p in hypoxia stress in human hepatic sinusoidal endothelial cells (HHSEC), and clarifying the relationship among them. The expression of lnc H19, NOX4 and miR-148b-3p in cirrhotic patients and hypoxic HHSEC were measured by RT-PCR. The nitric oxide and hydrogen peroxide content in HHSEC were determined using ultraviolet chromatometry. The protein levels of NOX4, endothelial NOS (eNOS) and phosphorylated eNOS (p-eNOS) were measured via western blotting. The interaction between NOX4 promoter and lnc H19/miR-148b-3p was measured by dual-luciferase reporter gene detection system. The present results indicated that the expressions of NOX4 mRNA and lnc H19 were increased but miR-148b-3p was decreased in both cirrhotic patients and hypoxic HHSEC. Further, hypoxia induced the up-regulation of hydrogen peroxide and the down-regulation of eNOS/NO signaling in HHSEC. And these symptoms were ameliorated by lnc H19 shRNA and miR-148b-3p mimics. But the beneficial effects of lnc H19 shRNA and miR-148b-3p mimics were further abolished by miR-148b-3p inhibitor and NOX4 over-expression, respectively. In addition, NOX4 was a direct, negatively regulated target of miR-148b-3p, and miR-148b-3p was negatively regulated by lnc H19. Collectively, lnc H19 is a negatively regulator of microRNA-148b-3p, and participate in hypoxia stress in HHSEC via positively regulating NOX4 and negatively regulating eNOS/NO signaling.
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Affiliation(s)
- Yiming Zhu
- Department of General Surgery, Shanghai Ninth People' Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, Shanghai, 200011, China
| | - Tao Ni
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People' Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, Shanghai, 200011, China
| | - Jiayun Lin
- Department of General Surgery, Shanghai Ninth People' Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, Shanghai, 200011, China
| | - Chihao Zhang
- Department of General Surgery, Shanghai Ninth People' Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, Shanghai, 200011, China
| | - Lei Zheng
- Department of General Surgery, Shanghai Ninth People' Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, Shanghai, 200011, China
| | - Meng Luo
- Department of General Surgery, Shanghai Ninth People' Hospital, School of Medicine, Shanghai Jiao Tong University, Huangpu, Shanghai, 200011, China.
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Ida S, Kojima Y, Hamaoka S, Urawa N, Araki J, Kaneko R, Murata K. Validity of Japanese version of SARC-F questionnaire in patients with chronic liver disease. J Gastroenterol Hepatol 2019; 34:947-953. [PMID: 30144377 DOI: 10.1111/jgh.14449] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM We aimed to examine the validity of the Japanese version of SARC-F questionnaire (SARC-F-J) that employs the diagnostic criteria for sarcopenia established by the Japan Society of Hepatology in patients with chronic liver disease. METHODS Subjects were outpatients at the Department of Hepatology at the Japanese Red Cross Ise Hospital, Japan. Evaluations were performed using the following self-administered questionnaires: SARC-F-J, Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), the Japanese version of the Falls Efficacy Scale (FES), and Kaigo-Yobo Checklist (CL). Based on the diagnostic criteria of the Japan Society of Hepatology, we diagnosed sarcopenia from the skeletal muscle index calculated using the iliopsoas muscle area at the third lumbar vertebra on computed tomography and from grip strength. To evaluate construct validity, we calculated the sensitivity, specificity, and positive and negative predictive values of SARC-F-J that used the diagnostic criteria of the Japan Society of Hepatology as reference. Furthermore, to evaluate convergent validity, we calculated Pearson's correlation coefficients between SARC-F-J and TMIG-IC, FES, and CL. RESULTS A total of 140 subjects were included in the analysis set. Sensitivity and specificity were 16.3% and 45.0% and 95.3% and 90.8% for men and women, respectively. The positive predictive value was 81.8% for both, whereas the negative predictive value was 47.1% and 64.5% for men and women, respectively. A significant correlation was seen between SARC-F-J and TMIG-IC, FES, and CL. CONCLUSIONS We believe that the SARC-F-J is a valid tool for patients with chronic liver disease.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie, Japan
| | - Yuji Kojima
- Department of Gastroenterology and Hepatology, Ise Red Cross Hospital, Ise-shi, Mie, Japan
| | - Shima Hamaoka
- Department of Gastroenterology and Hepatology, Ise Red Cross Hospital, Ise-shi, Mie, Japan
| | - Naohito Urawa
- Department of Gastroenterology and Hepatology, Ise Red Cross Hospital, Ise-shi, Mie, Japan
| | - Jun Araki
- Department of Gastroenterology and Hepatology, Ise Red Cross Hospital, Ise-shi, Mie, Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie, Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie, Japan
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Tada T, Kumada T, Toyoda H, Yasuda S, Koyabu T, Nakashima M. Impact of Branched-Chain Amino Acid Granule Therapy in Patients with Hepatocellular Carcinoma Who Have Normal Albumin Levels and Low Branched-Chain Amino Acid to Tyrosine Ratios. Nutr Cancer 2019; 71:1132-1141. [PMID: 30955354 DOI: 10.1080/01635581.2019.1597905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Serum albumin has been reported to be a useful indicator of liver function and branched-chain amino acid (BCAA) therapy is associated with a lower incidence of hepatocellular carcinoma (HCC). We investigated the impact of BCAA granule therapy on overall survival and disease-specific survival in patients with normal albumin levels and low BCAA to tyrosine ratio (BTR)s who had treatment-naïve HCC. Overall survival and disease-specific survival was analyzed in 78 patients with HCC who were treated (n = 27) or not treated (n = 51) with BCAAs. Twenty-six patients died during the follow-up period. There were 19, 5, and 2 patients who died due to HCC, hepatic failure, and non-liver-related disease, respectively. Multivariate analysis for factors associated with overall survival indicated that BCAA therapy was independently associated with good prognosis in patients with HCC (hazard ratio [HR], 0.317; 95% confidence interval [CI], 0.123-0.813; P = 0.017). In addition, multivariate analysis using competing risks methods indicated that BCAA therapy is independently associated with reduction of disease-specific mortality (HR, 0.216; 95% CI, 0.068-0.689; P = 0.001). In conclusion, BCAA therapy improved both overall survival and disease-specific survival in HCC patients with low BTRs despite having normal albumin levels.
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Affiliation(s)
- Toshifumi Tada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital , Ogaki , Gifu , Japan
| | - Takashi Kumada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital , Ogaki , Gifu , Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital , Ogaki , Gifu , Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital , Ogaki , Gifu , Japan
| | - Takahiro Koyabu
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital , Ogaki , Gifu , Japan
| | - Megumi Nakashima
- Department of Pharmacy, Ogaki Municipal Hospital , Ogaki , Gifu , Japan
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