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Thuluvath AJ, Forsgren MF, Ladner DP, Tevar AD, Duarte-Rojo A. Utilizing a novel MRI technique to identify adverse muscle composition in end-stage liver disease: A pilot study. Ann Hepatol 2024; 29:101508. [PMID: 38719079 PMCID: PMC11250914 DOI: 10.1016/j.aohep.2024.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/08/2024] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION AND OBJECTIVES Sarcopenia is a common complication of end-stage liver disease (ESLD), but its exact relationship to myosteatosis and frailty remains unclear. In this pilot study, we tested the feasibility of a specialized MRI protocol and automated image analysis in patients with ESLD. MATERIALS AND METHODS In a single-center prospective study, adult liver transplant candidates with ESLD underwent assessment of muscle composition between 3/2022 and 6/2022 using the AMRA® MAsS Scan. The primary outcome of interest was feasibility of the novel MRI technique in patients with ESLD. We also tested if thigh muscle composition correlated with validated measures of frailty and sarcopenia. RESULTS Eighteen subjects (71 % male, mean age 59 years) were enrolled. The most common etiologies of cirrhosis were alcohol-related liver disease (44 %) and non-alcohol-associated fatty liver disease (33 %), with a mean MELD-Na of 13 (± 4). The mean time needed to complete the MRI protocol was 14.9 min and only one patient could not complete it due to metal hardware in both knees. Forty-one percent of patients had adverse muscle composition (high thigh fat infiltration and low-fat free muscle volume) and these patients were more likely to have undergone a recent large volume paracentesis (43 % vs. 0 %, p < 0.02). The adverse muscle composition group performed significantly worse on the 6-minute walk test compared to the remainder of the cohort (379 vs 470 m, p < 0.01). CONCLUSIONS The AMRA® MAsS Scan is feasible to perform in patients with ESLD and can be used to quantify myosteatosis, a marker of muscle quality and potentially muscle functionality in ESLD.
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Affiliation(s)
- Avesh J Thuluvath
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Division of Gastroenterology & Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University.
| | - Mikael F Forsgren
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; AMRA Medical AB, Linköping, Sweden
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Division of Transplant, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amit D Tevar
- Starzl Transplantation Institute, University of Pittsburgh Medical Center, and Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andres Duarte-Rojo
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Division of Gastroenterology & Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University
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2
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Olson SL, Polineni P, Schwartz WAH, Thuluvath AJ, Duarte-Rojo A, Ladner DP. Comparing Functional Frailty and Radiographic Sarcopenia as Predictors of Outcomes After Liver Transplant. Clin Transplant 2024; 38:e15412. [PMID: 39049617 DOI: 10.1111/ctr.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/12/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Frailty and sarcopenia are associated with an increased risk of hospitalization and mortality in patients with end-stage liver disease. The ability to identify frail patients at risk of adverse outcomes could help optimize liver transplant (LT) evaluations and pre-transplant care. This study compared sarcopenia, via L3-psoas muscle index (L3-PMI), to frailty, via liver frailty index (LFI) and analyzed associated outcomes after liver transplantation (LT). METHODS A retrospective review of consecutive LT-recipients with cross-sectional abdominal/pelvic imaging were reviewed over 5 years at a single transplant center. RESULTS Four hundred and twenty-six patients underwent transplant during this study interval; 31% of patients were sarcopenic. Two hundred eight patients underwent LFI evaluation: 25% were frail, 59% were prefrail, and 16% were robust. Sarcopenic patients had higher LFI scores indicating greater frailty (p = 0.02). Both sarcopenia and LFI-frailty were associated with significantly higher MELD-Na scores. Length of post-LT hospital stay was increased in sarcopenic (mean 14 vs. nonsarcopenic 11 days, p = 0.02) and LFI-frail patients (mean 13 vs. 10 prefrail, 8 robust, p = 0.04). As a categorical variable, neither LFI-frailty nor sarcopenia were significantly associated with reduced survival at 1-year (robust 100%, prefrail 93.5%, frail 91.1%, p = 0.31) (nonsarcopenic 94.4%, sarcopenic 91.4%, p = 0.30). However, LFI score was significantly associated with mortality at 1-year (OR 2.133, p = 0.047). CONCLUSIONS Radiographic sarcopenia is a suitable proxy for in-person frailty assessment as both L3-PMI and LFI capture frail patients' pre-LT. However, physical assessment with frailty better predicts 1-year mortality post-LT than the measurement of muscle mass.
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Affiliation(s)
- Sydney L Olson
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Praneet Polineni
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William Alexander Henry Schwartz
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Avesh J Thuluvath
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andres Duarte-Rojo
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Organ Transplantation, Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
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3
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Harris SJ, Stine JG. Frailty in liver transplantation: Exploring prescribing exercise as medicine to improve patient outcomes. Liver Int 2024. [PMID: 38899635 DOI: 10.1111/liv.15986] [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: 04/01/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
Liver transplantation (LT) represents a curative avenue for individuals with advanced chronic liver disease. Given the inherent illness severity of LT candidates, identifying patients at greater risk for adverse outcomes before and after transplantation is paramount. Approximately 50% of cirrhotic patients are frail and have considerable functional impairment. Various measures have been used to assess frailty, including performance-based tests and functional status evaluations. Frailty carries significant prognostic implications and predicts both mortality and pre- and post-LT complications. Contributing factors to frailty in this population include sarcopenia, malnutrition, inflammation, and psychosocial factors. Recognizing the prevalence of frailty among LT candidates, exercise interventions have been developed to improve physical frailty and offer potential to improve patient outcomes. While many interventions have demonstrated efficacy without notable adverse events, the absence of a universally accepted standard for exercise prescription underscores the variability in intervention elements and patient adherence. Given the safety profile of exercise interventions, there remains a critical need for standardized protocols and guidelines to optimize exercise regimens for LT candidates. This review delves into the landscape of frailty among LT candidates, elucidating its etiological underpinnings, impact on outcomes, utilization of exercise interventions, and the efficacy of exercise programs in reducing the burden frailty in those awaiting LT.
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Affiliation(s)
- Sara J Harris
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Fatty Liver Program, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Liver Center, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, The Pennsylvania State University - College of Medicine, Hershey, Pennsylvania, USA
- Cancer Institute, Penn State Health - Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Campos-Varela I, Castells L, Quiroga S, Vargas V, Simon-Talero M. Frailty and sarcopenia in patients with acute-on-chronic liver failure: Assessment and risk in the liver transplant setting. Ann Hepatol 2024; 29:101515. [PMID: 38851394 DOI: 10.1016/j.aohep.2024.101515] [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: 10/30/2023] [Revised: 12/17/2023] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
Frailty and sarcopenia are well-recognized factors related to worse outcomes in patients with cirrhosis, including liver transplant (LT) candidates. Implications of pre-LT functional and muscle deterioration also affect post-LT outcomes. Patients with cirrhosis and acute-on-chronic liver failure (ACLF) have a lower survival rate, both before and after LT. There is a need to better identify those patients with ACLF who would benefit from LT. This review aims to present the available data about frailty and sarcopenia in patients with ACLF in the LT setting. An exhaustive review of the published literature was conducted. Data regarding frailty and sarcopenia in LT candidates with ACLF are scarce and heterogeneous. Studies evaluating frailty and sarcopenia in critically ill patients outside the liver literature are also presented in this review to enrich the knowledge of this field in expansion. Frailty and sarcopenia seem to contribute to worse outcomes in LT candidates with ACLF, both before and after LT. Sarcopenia evaluation may be the most prudent approach for those very sick patients. Skeletal muscle index assessed by computed tomography is recommended to evaluate sarcopenia. The role of muscle ultrasound and bioelectrical impedance analysis is to be determined. Frailty and sarcopenia are crucial factors to consider on a case-by-case basis in LT candidates with ACLF to improve patient outcomes.
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Affiliation(s)
- Isabel Campos-Varela
- Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Lluis Castells
- Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergi Quiroga
- Radiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor Vargas
- Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Macarena Simon-Talero
- Liver Unit, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut of Research (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Perdiguero GG, Spina JC, Martínez J, Savluk L, Saidman J, Bonifacio M, Bakken S, Padilla M, Gallego-Clemente E, Moreno-González V, De Santibañes M, Marciano S, De Santibañes E, Gadano A, Pekolj J, Abraldes JG, Mauro E. Enhancing ACLF prediction by integrating sarcopenia assessment and frailty in liver transplant candidates on the waiting list. JHEP Rep 2024; 6:100985. [PMID: 38384670 PMCID: PMC10879792 DOI: 10.1016/j.jhepr.2023.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 02/23/2024] Open
Abstract
Background & Aims Malnutrition, sarcopenia, and frailty are prevalent in cirrhosis. We aimed to assess the correlation between assessment tools for malnutrition, sarcopenia, and frailty in patients on the liver transplant (LT) waiting list (WL), and to identify a predictive model for acute-on-chronic liver failure (ACLF) development. Methods This prospective single-center study enrolled consecutive patients with cirrhosis on the WL for LT (May 2019-November 2021). Assessments included subjective global assessment, CT body composition, skeletal muscle index (SMI), ultrasound thigh muscle thickness, sarcopenia HIBA score, liver frailty index (LFI), hand grip strength, and 6-minute walk test at enrollment. Correlations were analyzed using Pearson's correlation. Competing risk regression analysis was used to assess the predictive ability of the liver- and functional physiological reserve-related variables for ACLF. Results A total of 132 patients, predominantly with decompensated cirrhosis (87%), were included. Our study revealed a high prevalence of malnutrition (61%), sarcopenia (61%), visceral obesity (20%), sarcopenic visceral obesity (17%), and frailty (10%) among participants. Correlations between the assessment tools for sarcopenia and frailty were poor. Sarcopenia by SMI remained prevalent when frailty assessments were not usable. After a median follow-up of 10 months, 39% of the patients developed ACLF on WL, while 28% experienced dropouts without ACLF. Multivariate analysis identified MELD-Na, SMI, and LFI as independent predictors of ACLF on the WL. The predictive model MELD-Na-sarcopenia-LFI had a C-statistic of 0.85. Conclusions The poor correlation between sarcopenia assessment tools and frailty underscores the importance of a comprehensive evaluation. The SMI, LFI, and MELD-Na independently predicted ACLF development in WL. These findings enhance our understanding of the relationship between sarcopenia, frailty, and ACLF in patients awaiting LT, emphasizing the need for early detection and intervention to improve WL outcomes. Impact and implications The relationship between sarcopenia and frailty assessment tools, as well as their ability to predict acute-on-chronic liver failure (ACLF) in patients on the liver transplant (LT) waiting list (WL), remains poorly understood. Existing objective frailty screening tests have limitations when applied to critically ill patients. The correlation between sarcopenia and frailty assessment tools was weak, suggesting that they may capture different phenotypes. Sarcopenia assessed by skeletal muscle index, frailty evaluated using the liver frailty index, and the model for end-stage liver disease-Na score independently predicted the development of ACLF in patients on the WL. Our findings support the integration of liver frailty index and skeletal muscle index assessments at the time of inclusion on the WL for LT. This combined approach allows for the identification of a specific patient subgroup with an increased susceptibility to ACLF, underscoring the importance of early implementation of targeted treatment strategies to improve outcomes for patients awaiting LT.
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Affiliation(s)
| | - Juan Carlos Spina
- Liver Transplant Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
- Radiology Department, Hospital Italiano de Bs As, Buenos Aires, Argentina
| | - Jorge Martínez
- Liver Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
| | - Lorena Savluk
- Liver Transplant Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
- Radiology Department, Hospital Italiano de Bs As, Buenos Aires, Argentina
| | - Julia Saidman
- Radiology Department, Hospital Italiano de Bs As, Buenos Aires, Argentina
| | | | - Sofia Bakken
- Liver Transplant Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
- Radiology Department, Hospital Italiano de Bs As, Buenos Aires, Argentina
| | - Marlene Padilla
- Liver Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
| | | | | | | | - Sebastián Marciano
- Liver Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
- Liver Transplant Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
| | | | - Adrían Gadano
- Liver Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
- Liver Transplant Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
| | - Juan Pekolj
- Liver Transplant Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
| | - Juan G. Abraldes
- Division of Gastroenterology, University of Alberta, CEGIIR, Edmonton, Canada
| | - Ezequiel Mauro
- Liver Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
- Liver Transplant Unit, Hospital Italiano de Bs. As., Buenos Aires, Argentina
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Zhao X, Kotha S, Nayyar D, Ma X, Lilly L, Castel H, Gupta S. Physiologic changes in the hepatopulmonary syndrome before and after liver transplant: A longitudinal and predictor analysis. Hepatology 2024; 79:636-649. [PMID: 37732952 PMCID: PMC10871618 DOI: 10.1097/hep.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/27/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND AND AIMS Hepatopulmonary syndrome (HPS) is a common complication of liver disease defined by abnormal oxygenation and intrapulmonary vascular dilatation, treated with liver transplantation. Little is known about changes in HPS physiological parameters over time. We sought to describe baseline clinical and physiological characteristics in HPS and their relationships, temporal changes in physiological parameters before and after transplant, and predictors of changes in oxygenation. APPROACH AND RESULTS This was a retrospective cohort study in the Canadian HPS Program (n = 132). Rates of change after diagnosis were: -3.7 (-6.4, -0.96) mm Hg/year for partial pressure of arterial oxygen (PaO 2 ); -26 (-96, 44) m/year for 6-minute walk distance, and 3.3% (-6.6, -0.011) predicted/year for diffusion capacity. Noninvasive shunt of ≥ 20% predicted a slower PaO 2 decline by 0.88 (0.36, 1.4) mm Hg/month. We identified 2 PaO 2 deterioration classes-"very severe disease, slow decliners" (PaO 2 45.0 mm Hg; -1.0 mm Hg/year); and "moderate disease, steady decliners" (PaO 2 65.5 mm Hg; -2.5 mm Hg/year). PaO 2 increased by 6.5 (5.3, 7.7) mm Hg/month in the first year after transplant. The median time to normalization was 149 (116, 184) days. Posttransplant improvement in PaO 2 was 2.5 (0.1, 4.9) mm Hg/month faster for every 10 mm Hg greater pretransplant orthodeoxia. CONCLUSIONS We present a large and long longitudinal data analysis in HPS. In addition to rates of physiological decline and improvement before and after liver transplantation, we present novel predictors of PaO 2 decline and improvement rates. Our findings enhance our understanding of the natural history of HPS and provide pathophysiologic clues. Importantly, they may assist providers in prognostication and prioritization before and after transplant.
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Affiliation(s)
- Xun Zhao
- Department of Gastroenterology and Hepatology, McGill University, Montreal, Canada
- Department of Multi-Organ Transplant, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Sreelakshmi Kotha
- Department of Hepatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Dhruv Nayyar
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Xiayi Ma
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Leslie Lilly
- Department of Multi-Organ Transplant, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Hélène Castel
- Department of Hepatology and Liver Transplantation, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
| | - Samir Gupta
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
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Santangeli E, Abbati C, Chen R, Di Carlo A, Leoni S, Piscaglia F, Ferri S. Pathophysiological-Based Nutritional Interventions in Cirrhotic Patients with Sarcopenic Obesity: A State-of-the-Art Narrative Review. Nutrients 2024; 16:427. [PMID: 38337711 PMCID: PMC10857546 DOI: 10.3390/nu16030427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
In recent decades, following the spread of obesity, metabolic dysfunction has come to represent the leading cause of liver disease. The classical clinical presentation of the cirrhotic patient has, therefore, greatly changed, with a dramatic increase in subjects who appear overweight or obese. Due to an obesogenic lifestyle (lack of physical activity and overall malnutrition, with an excess of caloric intake together with a deficit of proteins and micronutrients), these patients frequently develop a complex clinical condition defined as sarcopenic obesity (SO). The interplay between cirrhosis and SO lies in the sharing of multiple pathogenetic mechanisms, including malnutrition/malabsorption, chronic inflammation, hyperammonemia and insulin resistance. The presence of SO worsens the outcome of cirrhotic patients, affecting overall morbidity and mortality. International nutrition and liver diseases societies strongly agree on recommending the use of food as an integral part of the healing process in the comprehensive management of these patients, including a reduction in caloric intake, protein and micronutrient supplementation and sodium restriction. Based on the pathophysiological paths shared by cirrhosis and SO, this narrative review aims to highlight the nutritional interventions currently advocated by international guidelines, as well as to provide hints on the possible role of micronutrients and nutraceuticals in the treatment of this multifaceted clinical condition.
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Affiliation(s)
- Ernestina Santangeli
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
| | - Chiara Abbati
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
| | - Rusi Chen
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
| | - Alma Di Carlo
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
| | - Simona Leoni
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
| | - Silvia Ferri
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
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Tuo S, Yeo YH, Chang R, Wen Z, Ran Q, Yang L, Fan Q, Kang J, Si J, Liu Y, Shi H, Li Y, Yuan J, Liu N, Dai S, Guo X, Wang J, Ji F, Tantai X. Prevalence of and associated factors for sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis. Clin Nutr 2024; 43:84-94. [PMID: 38016243 DOI: 10.1016/j.clnu.2023.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Sarcopenia is associated with poor outcomes in patients with cirrhosis. However, the prevalence of and associated factors for developing sarcopenia in this population remain to be determined. OBJECTIVES This study aimed to summarize the prevalence, characteristics, and associated factors of sarcopenia in patients with cirrhosis. METHODS Electronic searches were performed from inception to June 9, 2022 to identify the eligible studies. We meta-analyzed the prevalence of sarcopenia in overall patients with cirrhosis and subgroups. Both crude and adjusted odds ratios (ORs) were pooled using the random effects model. RESULTS A total of 55 studies involving 13,158 patients from 17 countries were included. The overall prevalence of sarcopenia was 40.1 % (95 % CI 35.4%-44.9 %) in patients with cirrhosis. The pooled prevalence was higher in males, Child-Pugh class C cirrhosis, decompensated stage, ascites, subjective global assessment class C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index) at a higher cutoff. In multivariate analysis, older age (adjusted OR 1.04, 95 % CI 1.00-1.07), male (adjusted OR 4.75, 95 % CI 2.72-8.28), lower body mass index (BMI) (adjusted OR 0.78, 95 % CI 0.73-0.83), alcoholic liver disease (ALD) (adjusted OR 1.43, 95 % CI 1.19-1.72), but not ascites and hepatic encephalopathy, were significantly associated with an increased risk of sarcopenia in patients with cirrhosis. CONCLUSION Sarcopenia is a prevalent complication, and older age, male patients, lower BMI, and patients with ALD are associated with an increased risk of sarcopenia in patients with cirrhosis.
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Affiliation(s)
- Shuyue Tuo
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rachel Chang
- Internal Medicine, Kaiser Permanente Mid-Atlantic States, Gaithersburg, MD, USA
| | - Zhang Wen
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qiuju Ran
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Longbao Yang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qing Fan
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junxiu Kang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jiaojiao Si
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haitao Shi
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yong Li
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jia Yuan
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Na Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shejiao Dai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaoyan Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jinhai Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, Shaanxi, China.
| | - Xinxing Tantai
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Clinical Research Center for Gastrointestinal Diseases of Shaanxi Province, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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9
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Yu R, Lai D, Leung G, Tam LY, Cheng C, Kong S, Tong C, Lu Z, Leung JCS, Chan A, Kwok T, Woo J. Translation, Cultural Adaptation, and Validation of the Cantonese Version of SarQoL in Hong Kong's Older Population: An Interviewer-Administered Questionnaire for Assessing Sarcopenia-Specific Quality of Life in Fieldwork Practice. Clin Interv Aging 2023; 18:1851-1861. [PMID: 37965637 PMCID: PMC10642387 DOI: 10.2147/cia.s431218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023] Open
Abstract
Objective This study examined the psychometric properties of the Cantonese version of the SarQoL® questionnaire. Participants A total of 118 (including 60 non-sarcopenic and 58 sarcopenic) community-dwelling older adults aged 65 years or above with Cantonese as their mother tongue. Methods Translation and cultural adaptation of the SarQoL were conducted using a standardized protocol. To validate the Cantonese SarQoL, psychometric properties including discriminative power, reliability (including internal consistency and test-retest reliability), and construct validity (including convergent and divergent validity), as well as floor and ceiling effects, were assessed. Results The translation of the questionnaire was completed without significant difficulties. Results indicated that the Cantonese SarQoL had (1) good discriminative power (sarcopenic participants had lower overall scores, mean = 66.1 vs 75.0, p < 0.001; the overall score was negatively predictive of the presence of sarcopenia, adjusted OR = 0.949, 95% CI = [0.912, 0.983]), (2) good internal consistency (Cronbach's alpha = 0.835; correlations between domain and overall scores ranged from 0.576 to 0.868), (3) excellent test-retest agreement (intraclass correlation coefficient = 0.801), (4) good construct validity (convergent: moderate to strong correlations were found between the overall score and almost all of the SF-36 and EQ-5D domains; divergent: weaker correlations were found between the overall score and SF-36 social functioning, ρ = -0.098, and EQ-5D self-care, ρ = -0.331), and (5) no floor or ceiling effect. Conclusion The Cantonese SarQoL is valid and reliable, and thus can be used as an interviewer-administered questionnaire for assessing sarcopenia-specific quality of life in fieldwork practice.
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Affiliation(s)
- Ruby Yu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Derek Lai
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Grace Leung
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Lok-Yan Tam
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Clara Cheng
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Sara Kong
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Cecilia Tong
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Zhihui Lu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Jason C S Leung
- The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Amany Chan
- The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- The Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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10
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Luo J, Yang D, Xu Z, Zhang D, Li M, Kong Y, Wang X, Ou X, Wang Y, Zhao X, Shan S, Yang Z, Jia J. A prospective study on the differential association of sarcopenia and frailty with health outcomes in cirrhotic patients. Dig Liver Dis 2023; 55:1533-1542. [PMID: 37482521 DOI: 10.1016/j.dld.2023.07.007] [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: 04/03/2023] [Revised: 06/14/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND To investigate the joint impact of sarcopenia and frailty on mortality and the development of decompensation in cirrhosis. METHODS Sarcopenia was assessed using the skeletal muscle mass index (SMI) by computed tomography, whereas frailty was measured using the Fried Frailty Phenotype (FFP). Cox proportional hazard regression and competing risks analysis were used to evaluate their association with adverse outcomes. RESULTS The prevalence of sarcopenia and frailty was 29.6% and 37.2%, respectively. Sarcopenia and frailty separately increased more than two times higher risk of all-cause mortality after adjustment for age, gender, Child-Turcotte-Pugh, and comorbidities. Co-occurrence of sarcopenia and frailty was associated with a higher incremental risk of mortality in patients with cirrhosis (HR = 4.16, 95% CI: 1.64-10.58, P = 0.003), but these two conditions didn't have significant interaction. Frailty, but not sarcopenia, was significantly associated with an increased cumulative incidence of liver-related mortality and decompensation after adjusting covariates. Subgroup analysis revealed that frailty shortened the liver-related survival of cirrhosis patients with male or higher liver severity based on MELD. CONCLUSIONS Co-occurrence of sarcopenia and frailty increased the risk of death in cirrhosis, but these two conditions didn't have a significant interaction association. Frailty, but not sarcopenia, was associated with more adverse outcomes in cirrhotic patients.
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Affiliation(s)
- Jia Luo
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong-An Road, Xicheng District, Beijing, China
| | - Dawei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing, China
| | - Zhengyu Xu
- Department of Medical Technology, Shaanxi University of Chinese Medicine, Middle section of Century Avenue, Xianyang 712046, Shaanxi, China
| | - Dai Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing, China
| | - Min Li
- Department of Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China
| | - Yuanyuan Kong
- Department of Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China
| | - Xiaoming Wang
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Beijing, China; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xiaojuan Ou
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Beijing, China; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Yu Wang
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Beijing, China; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xinyan Zhao
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Beijing, China; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Shan Shan
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Beijing, China; National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 Yong-An Road, Beijing, China.
| | - Jidong Jia
- Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Beijing, China; National Clinical Research Center for Digestive Diseases, Beijing, China.
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11
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Tandon P, Zanetto A, Piano S, Heimbach JK, Dasarathy S. Liver transplantation in the patient with physical frailty. J Hepatol 2023; 78:1105-1117. [PMID: 37208097 PMCID: PMC10825673 DOI: 10.1016/j.jhep.2023.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 05/21/2023]
Abstract
Frailty is a decline in functional reserve across multiple physiological systems. A key component of frailty is sarcopenia, which denotes a loss of skeletal muscle mass and impaired contractile function that ultimately result in physical frailty. Physical frailty/sarcopenia are frequent and contribute to adverse clinical outcomes before and after liver transplantation. Frailty indices, including the liver frailty index, focus on contractile dysfunction (physical frailty), while cross-sectional image analysis of muscle area is the most accepted and reproducible measure to define sarcopenia. Thus, physical frailty and sarcopenia are interrelated. The prevalence of physical frailty/sarcopenia is high in liver transplant candidates and these conditions have been shown to adversely impact clinical outcomes including mortality, hospitalisations, infections, and cost of care both before and after transplantation. Data on the prevalence of frailty/sarcopenia and their sex- and age-dependent impact on outcomes are not consistent in patients on the liver transplant waitlist. Physical frailty and sarcopenic obesity are frequent in the obese patient with cirrhosis, and adversely affect outcomes after liver transplantation. Nutritional interventions and physical activity remain the mainstay of management before and after transplantation, despite limited data from large scale trials. In addition to physical frailty, there is recognition that a global evaluation including a multidisciplinary approach to other components of frailty (e.g., cognition, emotional, psychosocial) also need to be addressed in patients on the transplant waitlist. Recent advances in our understanding of the underlying mechanisms of sarcopenia and contractile dysfunction have helped identify novel therapeutic targets.
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Affiliation(s)
- Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alberto Zanetto
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Italy
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine - DIMED, University and Hospital of Padova, Padova, Italy
| | - Julie K Heimbach
- William J von Liebig Transplant Center Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - Srinivasan Dasarathy
- Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, USA
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12
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Bot D, Lucassen C, Werkman M, van Dijk S, Feshtali SS, Tushuizen ME, van Hoek B. Skeletal muscle mass in patients with end-stage liver disease: Not only muscle size but especially muscle quality matters in relation to physical fitness. Clin Nutr ESPEN 2023; 55:407-413. [PMID: 37202075 DOI: 10.1016/j.clnesp.2023.04.005] [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: 12/09/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Physical fitness is an important modifiable factor related to quality of life. Sarcopenia and myosteatosis are associated with morbidity and mortality in patients with end-stage liver disease (ESLD). However, their relationship with physical fitness has not been established yet. Therefore, the main purpose of this study was to investigate the association between both low skeletal muscle index (SMI) and myosteatosis with physical fitness in patients with ESLD. METHODS In this retrospective cross-sectional cohort study, a cohort of patients with ESLD who were evaluated for liver transplantation (LT) was included. Physical fitness was reflected by cardiorespiratory fitness (CRF) and skeletal muscle strength, as measured by the 6-min walking distance (6MWD) and handgrip strength (HGS), respectively. Both were included in routine LT evaluation. Skeletal Muscle Index (SMI) and Muscle Radiation Attenuation (MRA) were evaluated based on the routine abdominal computed tomography. Linear and logistic regression analyses were performed. RESULTS Out of the 130 patients 94 (72%) were male, mean age was 56 ± 11 years. Myosteatosis was significantly associated with low 6MWD as percentage of predicted (β = -12.815 (CI -24.608 to -1.022, p-value 0.034)) as well as with low absolute 6MWD (<250 m) (OR 3.405 (CI 1.134-10.220, p-value 0.029)). No association was found between SMI and/or myosteatosis with HGS, or between SMI and 6MWD. CONCLUSION In contrast to SMI, myosteatosis is associated with low CRF. Neither low SMI nor myosteatosis was associated with skeletal muscle strength. Therefore physical exercise training might be especially beneficial for LT candidates with myosteatosis.
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Affiliation(s)
- Daphne Bot
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Claudia Lucassen
- Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten Werkman
- Department of Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Sylvia van Dijk
- Department of Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, LUMC Transplantation Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, LUMC Transplantation Center, Leiden University Medical Center, Leiden, the Netherlands
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13
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Coelho MPP, de Castro PASV, de Vries TP, Colosimo EA, Bezerra JMT, Rocha GA, Silva LD. Sarcopenia in chronic viral hepatitis: From concept to clinical relevance. World J Hepatol 2023; 15:649-665. [PMID: 37305369 PMCID: PMC10251280 DOI: 10.4254/wjh.v15.i5.649] [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: 12/31/2022] [Revised: 02/17/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
Although the frequency of metabolic risk factors for cirrhosis and hepatocellular carcinoma (HCC) is increasing, chronic hepatitis B (CHB) and chronic hepatitis C (CHC) remain the most relevant risk factors for advanced liver disease worldwide. In addition to liver damage, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with a myriad of extrahepatic manifestations including mixed cryoglobulinaemia, lymphoproliferative disorders, renal disease, insulin resistance, type 2 diabetes, sicca syndrome, rheumatoid arthritis-like polyarthritis, and autoantibody production. Recently, the list has grown to include sarcopenia. Loss of muscle mass or muscle function is a critical feature of malnutrition in cirrhotic patients and has been found in approximately 23.0%-60.0% of patients with advanced liver disease. Nonetheless, among published studies, there is significant heterogeneity in the aetiologies of hepatic diseases and measurement methods used to determine sarcopenia. In particular, the interaction between sarcopenia, CHB and CHC has not been completely clarified in a real-world setting. Sarcopenia can result from a complex and multifaceted virus-host-environment interplay in individuals chronically infected with HBV or HCV. Thus, in the present review, we provide an overview of the concept, prevalence, clinical relevance, and potential mechanisms of sarcopenia in patients with chronic viral hepatitis, with an emphasis on clinical outcomes, which have been associated with skeletal muscle loss in these patients. A comprehensive overview of sarcopenia in individuals chronically infected with HBV or HCV, independent of the stage of the liver disease, will reinforce the necessity of an integrated medical/nutritional/physical education approach in the daily clinical care of patients with CHB and CHC.
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Affiliation(s)
- Marta Paula Pereira Coelho
- Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Pedro Alves Soares Vaz de Castro
- Medical Undergraduate Student, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Thaís Pontello de Vries
- Sciences Applied to Adult Health Care Post-Graduate Programme, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Enrico Antônio Colosimo
- Department of Statistics, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Juliana Maria Trindade Bezerra
- Department of Biological Sciences, Universidade Estadual do Maranhão, Açailândia 65715-000, Maranhão, Brazil
- Post-Graduate Programme of Animal Science, Universidade Estadual do Maranhão, São Luiz do Maranhão 65.055-310, Maranhão, Brazil
| | - Gifone Aguiar Rocha
- Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
| | - Luciana Diniz Silva
- Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil.
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14
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Cox-Flaherty K, Moutchia J, Krowka MJ, Al-Naamani N, Fallon MB, DuBrock H, Forde KA, Krok K, Doyle MF, Kawut SM, Ventetuolo CE. Six-Minute walk distance predicts outcomes in liver transplant candidates. Liver Transpl 2023; 29:521-530. [PMID: 36691988 PMCID: PMC10101910 DOI: 10.1097/lvt.0000000000000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/06/2022] [Indexed: 01/25/2023]
Abstract
A 6-minute walk test is a simple tool for assessing submaximal exercise capacity. We sought to determine whether a 6-minute walk distance (6MWD) predicts outcomes in patients with cirrhosis. The Pulmonary Vascular Complications of Liver Disease 2 study is a multicenter, prospective cohort study that enrolled adults with portal hypertension during liver transplantation evaluation. We excluded subjects with an incident or prevalent portopulmonary hypertension. The 6-minute walk test was performed using standardized methods. Cox proportional hazards modeling and multivariable linear regression analysis were performed to determine the relationship between baseline 6MWD and outcomes. The study sample included 352 subjects. The mean 6MWD was 391±101 m. For each 50-meter decrease in 6MWD, there was a 25% increase in the risk of death (HR 1.25, 95% CI [1.11, 1.41], p < 0.001) after adjustment for age, gender, body mass index, MELD-Na, and liver transplant as a time-varying covariate. In a multistate model, each 50-meter decrease in 6MWD was associated with an increased risk of death before the liver transplant ( p < 0.001) but not after the transplant. 6MWD was similar to MELD-Na in discriminating mortality. Each 50-meter decrease in 6MWD was associated with an increase in all-cause ( p < 0.001) and transplant-free hospitalizations ( p < 0.001) in multivariable models for time-to-recurrent events. Shorter 6MWD was associated with worse Short Form-36 physical ( p < 0.001) and mental component scores ( p = 0.05). In conclusion, shorter 6MWD is associated with an increased risk of death, hospitalizations, and worse quality of life in patients evaluated for liver transplantation. The 6-minute walk distance may be a useful adjunct for risk assessment in patients undergoing liver transplant evaluation.
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Affiliation(s)
| | - Jude Moutchia
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nadine Al-Naamani
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Kimberly A. Forde
- Department of Medicine, Lewis Katz School of Medicine at Temple University, PA, USA
| | - Karen Krok
- Department of Medicine, Penn State Health Milton S. Hershey Medical Center
| | | | - Steven M. Kawut
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Corey E. Ventetuolo
- Departments of Medicine, Brown University, Providence, RI, USA
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
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15
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Musio A, Perazza F, Leoni L, Stefanini B, Dajti E, Menozzi R, Petroni ML, Colecchia A, Ravaioli F. Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease. Int J Mol Sci 2023; 24:ijms24087517. [PMID: 37108675 PMCID: PMC10139188 DOI: 10.3390/ijms24087517] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Chronic liver disease (CLD), including non-alcoholic fatty liver disease (NAFLD) and its advanced form, non-alcoholic steatohepatitis (NASH), affects a significant portion of the population worldwide. NAFLD is characterised by fat accumulation in the liver, while NASH is associated with inflammation and liver damage. Osteosarcopenia, which combines muscle and bone mass loss, is an emerging clinical problem in chronic liver disease that is often underappreciated. The reductions in muscle and bone mass share several common pathophysiological pathways; insulin resistance and chronic systemic inflammation are the most crucial predisposing factors and are related to the presence and gravity of NAFLD and to the worsening of the outcome of liver disease. This article explores the relationship between osteosarcopenia and NAFLD/MAFLD, focusing on the diagnosis, prevention and treatment of this condition in patients with CLD.
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Affiliation(s)
- Alessandra Musio
- Department of Medical and Surgical Sciences, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federica Perazza
- Department of Medical and Surgical Sciences, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Laura Leoni
- Department of Medical and Surgical Sciences, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy
| | - Bernardo Stefanini
- Department of Medical and Surgical Sciences, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elton Dajti
- Department of Medical and Surgical Sciences, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Renata Menozzi
- Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena and Reggio Emilia, Largo del Pozzo 71, 41125 Modena, Italy
| | - Maria Letizia Petroni
- Department of Medical and Surgical Sciences, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Gastroenterology Unit, Department of Medical Specialties, University Hospital of Modena, University of Modena & Reggio Emilia, 41121 Modena, Italy
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16
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Sarcopenia and Frailty in Cirrhosis. Med Clin North Am 2023; 107:589-604. [PMID: 37001955 DOI: 10.1016/j.mcna.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Sarcopenia and frailty are frequent in cirrhosis, and both contribute to increased morbidity and mortality. The complex pathogenesis of sarcopenia in cirrhosis is mainly determined by hyperammonemia and malnutrition. Sarcopenia/frailty screening and reevaluation should be undertaken in all cirrhotic patients. Frailty tests are useful in the ambulatory setting, whereas the computed tomography scan is the diagnostic gold standard for sarcopenia. To manage sarcopenia/frailty, a multidisciplinary team should develop a personalized comprehensive care plan that includes patient education, protein/calorie intake goals, late evening meals, exercise programs, and micronutrient replenishment. In selected patients, branched-chain amino acid and testosterone supplements may also be beneficial.
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17
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Mahmoodi M, Hejazi N, Bagheri Z, Nasimi N, Clark CCT, Moosavi M, Dabbaghmanesh MH, Mazloom Z. Validation of the Persian version of the sarcopenia-specific quality of life questionnaire (SarQoL ®-IR). Aging Clin Exp Res 2023; 35:137-145. [PMID: 36289155 DOI: 10.1007/s40520-022-02255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/11/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The sarcopenia quality of life (SarQoL)® questionnaire is a specific tool to measure QoL in sarcopenia. The aim of this study was to validate the SarQoL® questionnaire for evaluation of sarcopenia-related quality of life in Iranian community-dwelling older adults. METHODS Validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability), and floor/ceiling effects of SarQoL® questionnaire were evaluated in the current study. Moreover, the SarQoL® questionnaire was compared with the Short-Form 36-item (SF-36) and the EuroQoL 5-Dimensions (EQ-5D) questionnaires. RESULTS Among 501 community-dwelling older adults, 128 elderly participants (including 88 sarcopenic individuals) were recruited for validation. Participants with sarcopenia had lower quality of life than non-sarcopenic individuals (Total Score: 39.37 ± 7.45 vs. 65.09 ± 7.85, p < 0.001). Also, the findings demonstrated a high internal consistency (Cronbach's alpha of 0.881), excellent test-retest reliability (ICC = 0.995, 95% CI 0.990-0.998), and no floor/ceiling effect of SarQoL® questionnaire. CONCLUSION This is the first study to confirm the reliability and validity of the Persian version of the SarQoL® for the measurement of quality of life among Iranian sarcopenic older adults.
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Affiliation(s)
- Marzieh Mahmoodi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Science, Shiraz, Iran
| | - Najmeh Hejazi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Science, Shiraz, Iran.
| | - Zahra Bagheri
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Nasimi
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Science, Shiraz, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Mahsa Moosavi
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Dabbaghmanesh
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Shiraz Endocrinology and Metabolism Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zohreh Mazloom
- Department of Clinical Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Science, Shiraz, Iran.
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18
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Sugiyama Y, Ishizu Y, Ando Y, Yokoyama S, Yamamoto K, Ito T, Imai N, Nakamura M, Honda T, Kawashima H, Ishikawa T, Ishigami M. An improved method to assess skeletal muscle mass in patients with liver cirrhosis based on computed tomography images. Hepatol Res 2022; 52:937-946. [PMID: 35921254 DOI: 10.1111/hepr.13820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/26/2022] [Accepted: 07/17/2022] [Indexed: 02/08/2023]
Abstract
AIM Conventionally, the skeletal muscle area with computed tomography (CT) attenuation ranging from -29 to +150 Hounsfield unit (HU) divided by height squared (the conventional skeletal muscle index [SMI]) was used as an index of skeletal muscle mass. However, it includes fat-infiltrated skeletal muscle, which is known to have poor function. This study aims to determine whether the low-fat SMI, which uses skeletal muscle mass with CT attenuation ranging from +30 to +150 HU, or conventional SMI appropriately reflects the function of skeletal muscle. METHODS We retrospectively analyzed 120 patients with cirrhosis whose handgrip strength was measured. Among them, 48 patients underwent a physical performance assessment such as liver frailty index (LFI) and short physical performance battery (SPPB), and 80 underwent quality of life (QOL) assessment. The relationships between each SMI and handgrip strength, LFI, SPPB, and QOL were evaluated. RESULTS Low-fat SMI was significantly correlated with handgrip strength (males, R = 0.393, p = 0.002; females, R = 0.423, p < 0.001) and LFI (males, R = -0.535, p = 0.035; females, R = -0.368, p = 0.039), whereas conventional SMI was not. When using low-fat SMI, patients with low skeletal muscle mass had significantly low handgrip strength, LFI, SPPB, and physical and social-related QOL score than those without. By contrast, no significant differences were found for any items when using conventional SMI. CONCLUSIONS Low-fat SMI is a good index of skeletal muscle mass that appropriately reflects skeletal muscle function.
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Affiliation(s)
- Yoshiaki Sugiyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Ando
- Department of Gastroenterology, Handa City Hospital, Handa, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Ishikawa
- Department of Radiological and Medical Laboratory Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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19
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Yoshioka Y, Oshima Y, Hata K, Sato S, Hamada R, Sato T, Kaido T, Munekage F, Ito T, Ikeguchi R, Uemoto S, Hatano E, Matsuda S. Factors associated with early postoperative exercise tolerance after living-donor liver transplantation. Clin Transplant 2022; 36:e14800. [PMID: 35993374 DOI: 10.1111/ctr.14800] [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: 03/26/2022] [Revised: 07/20/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Physical dysfunction, including exercise intolerance, is a major factor for delayed societal reintegration for patients who underwent living-donor liver transplantation (LDLT). However, what may contribute to early postoperative physical function is not well known. The purpose of this study is to elucidate the perioperative factors affecting early posttransplant exercise intolerance. METHODS 103 consecutive patients who underwent LDLT were enrolled, and 68 patients were retrospectively analyzed. We examined the relationship between postoperative exercise tolerance evaluated by a 6-minute walking distance (6MWD) at discharge after surgery and demographic data, surgical information, preoperative physical function, clinical course, and the postoperative decline in physical function with univariate and multivariate analyses. RESULTS Almost all patients were discharged within 3 months after surgery. The postoperative 6MWD was 408 ± 94 m (68 [61-84]% of the predicted value), and patients who had a low %6MWD at discharge had significantly lower preoperative physical function than patients who had a high %6MWD at discharge (grip strength: 29.8 ± 8.9 kgf vs. 23.0 ± 8.8 kgf, P < .01, knee extensor strength: 138.9 ± 59.4 Nm vs. 95.2 ± 42.1 Nm, P < .01). Multivariate analysis revealed that preoperative knee extensor strength (standardized β = 0.35, P < .01) and first postoperative walking day (standardized β = -0.22, P = .04) were independently associated with the postoperative %6MWD. CONCLUSION These results suggest that maintaining preoperative muscle strength and allowing for early postoperative mobilization might help to enhance the recovery of physical function and facilitate the patient's social reintegration after LDLT.
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Affiliation(s)
- Yuji Yoshioka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Yohei Oshima
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Koichiro Hata
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.,Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Tatsuya Sato
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan.,Health Science, Graduate School of Health Science, Kio University, Nara, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Gastroenterological and General Surgery, St. Luke's International University Hospital, Tokyo, Japan
| | - Fumiaki Munekage
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Ito
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Shiga University of Medical Science, Otsu, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
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20
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Jetten WD, Hogenbirk RNM, Van Meeteren NLU, Cuperus FJC, Klaase JM, De Jong R. Physical Effects, Safety and Feasibility of Prehabilitation in Patients Awaiting Orthotopic Liver Transplantation, a Systematic Review. Transpl Int 2022; 35:10330. [PMID: 36157271 PMCID: PMC9492850 DOI: 10.3389/ti.2022.10330] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/24/2022] [Indexed: 11/13/2022]
Abstract
Prehabilitation improves surgical outcomes in patients undergoing surgery. However, patients preparing for orthotopic liver transplantation (OLT) are physically “frail” and suffer from comorbidities that generally hamper physical activity. This systematic review aims to evaluate the physical effects, safety and feasibility of prehabilitation in OLT candidates. Relevant articles were searched, in Embase, Web of Science, Cochrane, Medline and Google Scholar, to December 2021. Studies reporting on specified preoperative exercise programs, including adult OLT candidates with end-stage liver disease, with a model for end-stage liver disease (MELD) score ≥12 or Child-Pugh classification B/C, were included. This resulted in 563 potentially eligible studies, out of which eight were selected for inclusion, consisting of 1,094 patients (male sex 68%; mean age 51–61 years; mean MELD score 12-21). Six of the included studies were classified as low-quality by the GRADE system, and three studies had high risk for ineffectiveness of the training program according to the i-CONTENT tool. Significant improvement was observed in VO2 peak, 6-minute walking distance, hand grip strength, liver frailty index and quality of life. Feasibility ranged from an adherence of 38%–90% in unsupervised-to >94% in supervised programs. No serious adverse events were reported. In conclusion, prehabilitation in patients awaiting OLT appears to improve aerobic capacity, and seems feasible and safe. However, larger clinical trials are required to accurately examine the preoperative and postoperative effects of prehabilitation in this specific patient population.
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Affiliation(s)
- Wesley D. Jetten
- Department of Anesthesiology, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
- *Correspondence: Wesley D. Jetten,
| | - Rianne N. M. Hogenbirk
- Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nico L. U. Van Meeteren
- Department of Anesthesiology, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
- Top Sector Life Sciences and Health (Health∼Holland), The Hague, Netherlands
| | - Frans J. C. Cuperus
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Joost M. Klaase
- Department of Surgery, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Renate De Jong
- Department of Anesthesiology, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
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21
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Garcia-Saenz-de-Sicilia M, Al-Obaid L, Hughes DL, Duarte-Rojo A. Mastering Core Recommendations during HEPAtology ROUNDS in Patients with Advanced Chronic Liver Disease. Semin Liver Dis 2022; 42:341-361. [PMID: 35764316 DOI: 10.1055/a-1886-5909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Efficient and thorough care of hospitalized patients with advanced chronic liver disease is of utter importance to improve outcomes and optimize quality of life. This requires understanding current evidence and best practices. To facilitate focus on up-to-date knowledge and a practical approach, we have created the HEPA-ROUNDS mnemonic while outlining a practical review of the literature with critical appraisal for the busy clinician. The HEPA-ROUNDS mnemonic provides a structured approach that incorporates critical concepts in terms of prevention, management, and prognostication of the most common complications frequently encountered in patients with advanced chronic liver disease. In addition, implementing the HEPA-ROUNDS mnemonic can facilitate education for trainees and staff caring for patients with advanced chronic liver disease.
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Affiliation(s)
| | - Lolwa Al-Obaid
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Dempsey L Hughes
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrés Duarte-Rojo
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Guarino M, Cossiga V, Becchetti C, Invernizzi F, Lapenna L, Lavezzo B, Lenci I, Merli M, Pasulo L, Zanetto A, Burra P, Morisco F. Sarcopenia in chronic advanced liver diseases: A sex-oriented analysis of the literature. Dig Liver Dis 2022; 54:997-1006. [PMID: 34789397 DOI: 10.1016/j.dld.2021.10.010] [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: 06/05/2021] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
Sarcopenia, defined as progressive and generalized loss of muscle mass and strength, is common in chronic liver disease. It significantly impacts the quality of life and increases the risk of liver-related complications and mortality in cirrhotic patients. Moreover, recent studies showed a negative impact of sarcopenia on patients awaiting liver transplantation (LT), on post-LT outcomes, and on response to hepatocellular carcinoma therapies. Data about the influence of sex on the incidence, prevalence, diagnosis and treatment of sarcopenia in chronic liver diseases are poor and conflicting. The aims of this review of the literature are to define sex differences in sarcopenic cirrhotic patients and to highlight the necessity of a sex stratified analysis in future studies. This analysis of the literature showed that most of the studies are retrospective, with a higher prevalence of sarcopenia in males, probably due to anatomical differences between the sexes. Moreover, diagnostic criteria for sarcopenia are different between studies, as there is not a defined cut-off and, as a consequence, no comparable results. In conclusion, sex seems to have an impact on sarcopenia, and future studies must accurately investigate its role in identifying and treating high-risk patients, reducing the negative impact of sarcopenia on the survival and quality of life of cirrhotic patients.
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Affiliation(s)
- Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy
| | - Valentina Cossiga
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy.
| | - Chiara Becchetti
- Hepatology, Department of Biomedical Research, University of Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland; Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Bruna Lavezzo
- Anesthesia and Intensive Care Unit 2, Liver Transplant Center, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Ilaria Lenci
- Department of Surgery Science, Hepatology and Liver Transplant Unit, Tor Vergata University, Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Luisa Pasulo
- Department of Clinical Medicine, Gastroenterology-Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy
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23
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Allen SL, Seabright AP, Quinlan JI, Dhaliwal A, Williams FR, Fine NHF, Hodson DJ, Armstrong MJ, Elsharkaway AM, Greig CA, Lai YC, Lord JM, Lavery GG, Breen L. The Effect of Ex Vivo Human Serum from Liver Disease Patients on Cellular Protein Synthesis and Growth. Cells 2022; 11:cells11071098. [PMID: 35406665 PMCID: PMC8997893 DOI: 10.3390/cells11071098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023] Open
Abstract
Sarcopenia is a common complication affecting liver disease patients, yet the underlying mechanisms remain unclear. We aimed to elucidate the cellular mechanisms that drive sarcopenia progression using an in vitro model of liver disease. C2C12 myotubes were serum and amino acid starved for 1-h and subsequently conditioned with fasted ex vivo serum from four non-cirrhotic non-alcoholic fatty liver disease patients (NAFLD), four decompensated end-stage liver disease patients (ESLD) and four age-matched healthy controls (CON) for 4- or 24-h. After 4-h C2C12 myotubes were treated with an anabolic stimulus (5 mM leucine) for 30-min. Myotube diameter was reduced following treatment with serum from ESLD compared with CON (−45%) and NAFLD (−35%; p < 0.001 for both). A reduction in maximal mitochondrial respiration (24% and 29%, respectively), coupling efficiency (~12%) and mitophagy (~13%) was identified in myotubes conditioned with NAFLD and ESLD serum compared with CON (p < 0.05 for both). Myostatin (43%, p = 0.04) and MuRF-1 (41%, p = 0.03) protein content was elevated in myotubes treated with ESLD serum compared with CON. Here we highlight a novel, experimental platform to further probe changes in circulating markers associated with liver disease that may drive sarcopenia and develop targeted therapeutic interventions.
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Affiliation(s)
- Sophie L. Allen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
| | - Alex P. Seabright
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
| | - Jonathan I. Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
| | - Amritpal Dhaliwal
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Felicity R. Williams
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Nicholas H. F. Fine
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK; (N.H.F.F.); (D.J.H.)
| | - David J. Hodson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK; (N.H.F.F.); (D.J.H.)
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TT, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, Churchill Hosptial, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 7LE, UK
| | - Matthew J. Armstrong
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Ahmed M. Elsharkaway
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Liver Unit, Queen Elizabeth Hospital Birmingham, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Carolyn A. Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Yu-Chiang Lai
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK; (N.H.F.F.); (D.J.H.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Janet M. Lord
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Gareth G. Lavery
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- Department of Biosciences, Nottingham Trent University, Nottingham NG1 8NS, UK
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (S.L.A.); (A.P.S.); (J.I.Q.); (C.A.G.); (Y.-C.L.)
- National Institute for Health Research, Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK; (A.D.); (F.R.W.); (M.J.A.); (A.M.E.); (J.M.L.); (G.G.L.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence:
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24
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Veronese N, Koyanagi A, Cereda E, Maggi S, Barbagallo M, Dominguez LJ, Smith L. Sarcopenia reduces quality of life in the long-term: longitudinal analyses from the English longitudinal study of ageing. Eur Geriatr Med 2022; 13:633-639. [PMID: 35212911 PMCID: PMC9151534 DOI: 10.1007/s41999-022-00627-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022]
Abstract
Aim To examine the association between sarcopenia at baseline and changes in quality of life at 10 years follow-up in a large representative sample of older English adults. Findings After considering numerous confounders, sarcopenia at baseline was associated with a higher incidence of poor quality of life. People having sarcopenia at baseline reported significantly lower values in CASP-19 after ten years of follow-up. Message Sarcopenia is an important and independent risk factor for poor quality of life in older people. Purpose Mixed findings exist for sarcopenia/quality of life (QoL) relationship. Moreover, the majority of studies in this area have utilized a cross-sectional design or specific clinical populations. Therefore, the aim of the present study was to examine the association between sarcopenia at baseline and QoL at 10 years follow-up in a large representative sample of older English adults. Methods Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index. QoL was measured using the CASP (control, autonomy, self-realisation and pleasure)-19, with higher values reflecting higher QoL. Multivariable logistic regression analysis was conducted to assess prospective associations between sarcopenia at baseline and poor QoL at follow-up; generalized linear model with repeated measures was used for reporting mean changes during follow-up between sarcopenia and not. Results Among 4044 older participants initially included at baseline (mean age: 70.7 years; 55.1% females), 376 had sarcopenia. In the multivariable analysis, after adjusting for several potential confounders, sarcopenia at baseline was associated with a higher incidence of poor QoL (odds ratio, OR = 5.82; 95% confidence interval, CI 3.45–9.82). After matching for QoL values at baseline and adjusting for potential confounders, people with sarcopenia reported significantly lower values in CASP-19 (mean difference = − 3.94; 95% CI − 4.77 to − 3.10). Conclusions In this large representative sample of older English adults, it was observed that sarcopenia at baseline was associated with worse scores of QoL at follow-up compared to those without sarcopenia at baseline. It may be prudent to target those with sarcopenia to improve QoL.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127, Palermo, Italy.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.,ICREA, Pg, Lluis Companys 23, 08010, Barcelona, Spain
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Maggi
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127, Palermo, Italy
| | - Ligia J Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127, Palermo, Italy
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
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25
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Abstract
Fatigue is a common symptom in patients with liver disease and has a significant impact on the health-related quality of life (HR-QoL). Its pathogenesis is poorly understood and is considered multifactorial. The liver is central in the pathogenesis of fatigue because it uniquely regulates much of the production, storage, and release of substrate for energy generation. Also, the liver "cross-talks" with the key organs that are responsible for this symptom complex-gut, skeletal muscle, and brain. Fatigue can have both peripheral (i.e., neuromuscular) and central (i.e., resulting from changes in neurotransmission within the brain) components. The treatment strategies for the management of fatigue are behavioral changes and pharmacotherapy, along with dietetic intervention and exercise. However, there is no consensus on management strategies for fatigue in patients with liver disease. This article gives an overview of fatigue as a concept, its pathophysiology, measures to evaluate fatigue in patients with liver disease, the impact of fatigue on chronic liver disease, assessment of fatigue in an appropriate clinical setting, and various interventions to manage fatigue.
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Key Words
- 6MWD, 6 min walk distance
- ACG, anterior cingulate gyrus
- ADL, activities of daily living
- BBB, blood-brain barrier
- BNST, bed nucleus of stria terminalis
- CEC, cerebral endothelial cell
- CFS, chronic fatigue syndrome
- CPET, cardio-pulmonary exercise testing
- CRH, corticotropin release hormone
- DA, dopamine
- FAS, fatigue assessment scale
- FIS, fatigue impact scale
- FSS, fatigue severity scale
- HGS, hand-grip strength
- HPA, hypothalamus-pituitary-adrenal
- HR-QoL, health-related quality of life
- IADL, instrumental activities of daily living
- ME, meningo-encephalomyelitis
- ME, meningoencephalitis
- NAFLD, nonalcoholic fatty liver disease
- NM, neuromuscular
- NO, nitric oxide
- PGE2, prostaglandins
- PRO, patient-reported outcomes
- PROMIS-F, patient-reported outcome measure information system for fatigue
- PSC, primary sclerosing cholangitis
- SAMe, S-adenosyl-methionine
- SN, substantia nigra
- SPPB, short-physical performance battery
- VAS-F, visual analog scalefatigue
- VTA, ventral tegmental area
- central fatigue
- chronic liver disease
- health-related quality of life [HR-QoL]
- iNOS, inducible nitric oxide synthase
- patient-related outcomes [PRO]
- peripheral fatigue
- vmPFC, ventromedial prefrontal cortex
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Affiliation(s)
| | - Dharmesh Kapoor
- Address for correspondence: Dr. Dharmesh Kapoor, Department of Hepatology, Yashoda Hospitals, Alexander X road, Secunderabad, Telangana, 500026, India.
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Physical Activity Patterns in Frail and Nonfrail Patients With End-Stage Liver Disease. J Clin Exp Hepatol 2021; 12:887-892. [PMID: 35677521 PMCID: PMC9168717 DOI: 10.1016/j.jceh.2021.10.013] [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: 02/11/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Frailty commonly complicates cirrhosis and is associated with poorer outcomes. While patients with cirrhosis may be sedentary, there are few comprehensive descriptions of their physical activity (PA) patterns related to frailty. Our aim was to identify PA characteristics that may be used in interventions to improve PA and reduce frailty. METHODS In a cross-sectional cohort study, forty patients with cirrhosis (mean age 63; 30 nonfrail, 10 frail) wore an accelerometer/thermal sensing armband for 7 days. Postural status (e.g., upright movement, upright sedentary, lying down), Metabolic Equivalent of Tasks (METs) and active bouts were identified. RESULTS Patients were highly sedentary most of the time (89 ± 7% and 85 ± 10% of the day, in frail and nonfrail cirrhotics, respectively). Compared with nonfrail cirrhotics, frail patients spent significantly shorter amount of time moving in an upright position (7% ± 5 vs. 12% ± 5, P = 0.013 in frail and nonfrail cirrhotics, respectively), had significantly fewer and shorter durations of active bouts per day (number of active bouts: 9 ± 12 vs. 19 ± 14; duration: 13.2 ± 1.5 min and 15.9 ± 2.6 min in frail and nonfrail cirrhotics, respectively), and had a lower amount of steps per wear time hours (41.7 ± 37.1 vs. 116.8 ± 85.4, P = 0.003 in frail and nonfrail, respectively). Traditional measures such as METs or aerobic bouts did not differ between groups. CONCLUSIONS Active bout measures, as opposed to more traditional measures such as METs, differentiate between frail and nonfrail cirrhotics suggesting they may be used to assess changes resulting from targeted interventions to improve physical activity.
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Le X, Wei Y, Hao D, Shan L, Li X, Shi Q, Ding D, Cheng X, Lim HLE, Ng BY. Psychometric Properties of the Chinese Version of the Sarcopenia and Quality of Life, a Quality of Life Questionnaire Specific for Sarcopenia. Calcif Tissue Int 2021; 109:415-422. [PMID: 33991208 DOI: 10.1007/s00223-021-00859-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/22/2021] [Indexed: 12/25/2022]
Abstract
A quality of life questionnaire specific to sarcopenia (SarQoL®) was successfully developed. There is a huge demand for translation and validation in Chinese. The aim of this study was to translate the SarQoL® into Chinese and investigate its psychometric properties. The translation and cross-cultural adaptation process recommended by the developers of the initial questionnaire was followed. A total of 159 participants were investigated. The translation process consists of five steps: (1) two bilinguals independently translate initial English to Chinese; (2) synthesize the two translations into one; (3) backward translations; (4) expert committee review and (5) test of the pre-final version. The validation consists of three parts: (1) validity (discriminative power, construct validity); (2) reliability (internal consistency, test-retest reliability) and (3) floor and ceiling effects. There was no difficulty in translation process. Regarding the validity, good discriminant validity {quality of life for sarcopenic subjects [35.56 (29.73-42.70)] vs. non-sarcopenic ones [73.22 (60.09-82.90)], p < 0.001} and consistent construct validity [high correlations (spearman's r) of SarQoL® with generic Short Form-36 version 2 questionnaire (0.250 to 0.824) and EuroQoL-5-Dimension questionnaire (- 0.114 to - 0.823)] were found in SarQoL®. Regarding reliability, high internal consistency (Cronbach's alpha coefficient was 0.867) and excellent test-retest reliability (intraclass coefficient correlation was 0.997, 95% CI 0.994-0.998) were found. No ceiling/floor effect was reflected. A valid SarQoL® questionnaire is now available for Chinese population. It can provide a better understanding of the sarcopenia disease burden and serve as a therapeutic outcome indicator in research.
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Affiliation(s)
- Xiaofeng Le
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555, YouYi East road, Xi'an, 710054, Shaanxi, China
| | - Yao Wei
- Department of Geriatrics, Honghui Hospital, Xi'an Jiaotong University, No. 555, YouYi East road, Xi'an, 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555, YouYi East road, Xi'an, 710054, Shaanxi, China.
| | - Lequn Shan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555, YouYi East road, Xi'an, 710054, Shaanxi, China
| | - Xiaoli Li
- Department of Geriatrics, Honghui Hospital, Xi'an Jiaotong University, No. 555, YouYi East road, Xi'an, 710054, Shaanxi, China
| | - Qifang Shi
- School of Nursing, Xi'an Jiaotong University, No. 28, Xianning West road, Xi'an, 710048, Shaanxi, China
| | - Ding Ding
- Faculty of Humanities and Social Sciences, Xi'an Jiaotong University, No. 28, Xianning West road, Xi'an, 710048, Shaanxi, China
| | - Xiang Cheng
- General Office, Shaanxi Bureau of National Food and Strategic Reserves Administration, No. 369, ChangYing West road, Xi'an, 710012, Shaanxi, China
| | - Hwee Ling Eileen Lim
- Spatial and Furniture Design, Nanyang Academy of Fine Arts' 14, Visenze Pte Ltd, Blk 67 Ayer Rajah Crescent, Singapore, 139950, Singapore
| | - Bao Yi Ng
- Chemistry, National University of Singapore, No. 21, Lower Kent Ridge Road, Singapore, 119077, Singapore
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28
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Dang TT, Ebadi M, Abraldes JG, Holman J, Ashmead J, Montano-Loza AJ, Tandon P. The 6-Minute Walk Test Distance Predicts Mortality in Cirrhosis: A Cohort of 694 Patients Awaiting Liver Transplantation. Liver Transpl 2021; 27:1490-1492. [PMID: 33905166 DOI: 10.1002/lt.26087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 01/13/2023]
Affiliation(s)
- ThucNhi T Dang
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Ebadi
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Juan G Abraldes
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Holman
- Transplant Services, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jon Ashmead
- Transplant Services, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Aldo J Montano-Loza
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
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Alexopoulos T, Vasilieva L, Kontogianni MD, Mani I, Alexopoulou A. Letter: patients who have both sarcopenia and frailty have similar prognosis to those with either condition separately. Aliment Pharmacol Ther 2021; 54:981-982. [PMID: 34506659 DOI: 10.1111/apt.16564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Theodoros Alexopoulos
- 2nd Department of Internal Medicine and Research Laboratory, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Larisa Vasilieva
- 2nd Department of Internal Medicine and Research Laboratory, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Meropi D Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Iliana Mani
- 2nd Department of Internal Medicine and Research Laboratory, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandra Alexopoulou
- 2nd Department of Internal Medicine and Research Laboratory, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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30
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West J, Gow PJ, Testro A, Chapman B, Sinclair M. Exercise physiology in cirrhosis and the potential benefits of exercise interventions: A review. J Gastroenterol Hepatol 2021; 36:2687-2705. [PMID: 33638197 DOI: 10.1111/jgh.15474] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/19/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022]
Abstract
Reduction in muscle mass is a highly prevalent phenomenon in cirrhosis and is now well-documented to be associated with significant morbidity and mortality. Research into muscle loss in cirrhosis remains limited by an ongoing poor understanding of its relationship with muscle function, physical activity, and aerobic capacity. Alterations in exercise physiology have been documented in studies of individuals with cirrhosis that provide important information on physical function that is not captured by simple quantification of muscle mass. Despite expert consensus recommending regular exercise in end-stage liver disease to maintain muscle mass and function, there is little evidence guiding clinicians as to which form of exercise or delivery mechanism is most effective. It also remains unproven whether any specific intervention can alter clinically relevant outcomes. This review article summarizes the available literature regarding the changes in exercise physiology observed in cirrhosis, the associated impact on physical capacity, and the results of existing trials that examine the potential benefits of exercise delivery in patients with cirrhosis, particularly pertaining to their impact on exercise physiology.
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Affiliation(s)
- Jack West
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul J Gow
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Brooke Chapman
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Marie Sinclair
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
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Prehabilitation-Driven Changes in Frailty Metrics Predict Mortality in Patients With Advanced Liver Disease. Am J Gastroenterol 2021; 116:2105-2117. [PMID: 34313620 DOI: 10.14309/ajg.0000000000001376] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Frailty is a predictor of morbidity and mortality in cirrhosis. Although evidence for prehabilitation is promising, the data for liver transplant (LT) candidates are limited. The primary aim of this study was to evaluate the effect of a novel prehabilitation strategy on changes in frailty metrics and survival in LT candidates. The secondary aim was to determine liver-related and extrahepatic conditions associated with frailty. METHODS In this ambispective cohort study, all patients underwent frailty assessment using the liver frailty index (LFI), 6-minute walk test, and gait speed test performed by a dedicated physical therapist. Home-based exercise prescription was individualized to each patient's baseline physical fitness. RESULTS We included 517 patients (59% men, median age 61 years, and a model for end-stage liver disease score of 12) evaluated during 936 PT visits. Frailty metrics were affected by age, sex, and liver-related parameters, but not by model for end-stage liver disease. Patients with nonalcoholic fatty liver disease and alcohol-related cirrhosis had worse frailty metrics by all tools. We demonstrated the feasibility of prehabilitation in improving both LFI and 6-minute walk test, particularly in adherent patients. A median LFI improvement of 0.3 in frail patients was associated with improved survival in univariate analysis. Compliance with physical therapist visits (hazards ratio = 0.35 [0.18-0.67] for 2 visits and hazards ratio = 0.54 [0.31-0.94] for ≥3 visits) was independently associated with increased survival. DISCUSSION Prehabilitation improves frailty metrics in LT candidates and is associated with a survival advantage. Our findings provide a framework for the standardized prehabilitation program in LT candidates while prioritizing compliance, adherence, and on-training LFI goal accomplishment.
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Sarcopenia-The Impact on Physical Capacity of Liver Transplant Patients. Life (Basel) 2021; 11:life11080740. [PMID: 34440484 PMCID: PMC8401329 DOI: 10.3390/life11080740] [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: 06/11/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
Optimizing patients' condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = -0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.
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33
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Bhanji RA, Watt KD. Physiologic Reserve Assessment and Application in Clinical and Research Settings in Liver Transplantation. Liver Transpl 2021; 27:1041-1053. [PMID: 33713382 DOI: 10.1002/lt.26052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
Physiologic reserve is an important prognostic indicator. Because of its complexity, no single test can measure an individual's physiologic reserve. Frailty is the phenotypic expression of decreased reserve and portends poor prognosis. Both subjective and objective tools have been used to measure one or more components of physiologic reserve. Most of these tools appear to predict pretransplant mortality, but only some predict posttransplant survival. Incorporation of these measures of physiologic reserve in the clinical and research settings including prediction models are reviewed, and the applicability to patient-related outcomes are discussed. Commonly used tools, in patients with cirrhosis, that have been associated with clinical outcomes were reviewed. The strength of subjective tools lies in low-cost, wide availability, and quick assessments at the bedside. A disadvantage of these tools is the manipulative capacity, restricting their value in allocation processes. The strength of objective tests lies in objective measurements and the ability to measure change. The disadvantages include complexity, increased cost, and limited accessibility. Heterogeneity in the definitions and tools used has prevented further advancement or a clear role in transplant assessment. Consistent use of objective tools, including the 6-minute walk test, gait speed, Liver Frailty Index, or Short Physical Performance Battery, are recommended in clinical and research settings.
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Affiliation(s)
- Rahima A Bhanji
- Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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34
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Tandon P, Montano-Loza AJ, Lai JC, Dasarathy S, Merli M. Sarcopenia and frailty in decompensated cirrhosis. J Hepatol 2021; 75 Suppl 1:S147-S162. [PMID: 34039486 PMCID: PMC9125684 DOI: 10.1016/j.jhep.2021.01.025] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
In patients with decompensated cirrhosis, sarcopenia and frailty are prevalent. Although several definitions exist for these terms, in the field of hepatology, sarcopenia has commonly been defined as loss of muscle mass, and frailty has been broadly defined as the phenotypic manifestation of the loss of muscle function. Prompt recognition and accurate assessment of these conditions are critical as they are both strongly associated with morbidity, mortality, poor quality of life and worse post-liver transplant outcomes in patients with cirrhosis. In this review, we describe the complex pathophysiology that underlies the clinical phenotypes of sarcopenia and frailty, their association with decompensation, and provide an overview of tools to assess these conditions in patients with cirrhosis. When available, we highlight data focusing on patients with acutely decompensated cirrhosis, such as inpatients, as this is an area of unmet clinical need. Finally, we discuss management strategies to reverse and/or prevent the development of sarcopenia and frailty, which include adequate nutritional intake of calories and protein, as well as regular exercise of at least moderate intensity, with a mix of aerobic and resistance training. Key knowledge gaps in our understanding of sarcopenia and frailty in decompensated cirrhosis remain, including best methods to measure muscle mass and function in the inpatient setting, racial/ethnic variation in the development and presentation of sarcopenia and frailty, and optimal clinical metrics to assess response to therapeutic interventions that translate into a reduction in adverse outcomes associated with these conditions.
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Affiliation(s)
- Puneeta Tandon
- Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Canada.
| | - Aldo J Montano-Loza
- Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Canada
| | - Jennifer C Lai
- Divisions of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA, USA
| | - Srinivasan Dasarathy
- Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Manuela Merli
- Department of Clinical Medicine, Gastroenterology, Sapienza University of Rome, Italy.
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35
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Williams FR, Milliken D, Lai JC, Armstrong MJ. Assessment of the Frail Patient With End-Stage Liver Disease: A Practical Overview of Sarcopenia, Physical Function, and Disability. Hepatol Commun 2021; 5:923-937. [PMID: 34141980 PMCID: PMC8183168 DOI: 10.1002/hep4.1688] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/14/2020] [Accepted: 01/24/2021] [Indexed: 12/22/2022] Open
Abstract
Frailty has emerged as a powerful predictor of clinical outcomes (e.g., decompensation, hospitalization, mortality) in patients with end-stage liver disease (ESLD). It is therefore of paramount importance that all patients with ESLD undergo an assessment of frailty, to support life and death decision making (i.e., candidacy for critical care, transplantation) and aid with prioritization of evolving prehabilitation services (i.e., nutrition, physiotherapy, psychotherapy). This article aims to provide a practical overview of the recent advances in the clinical, radiological, and remote assessment tools of the frail patient with ESLD. Historically, clinicians have incorporated an assessment of frailty using the "end-of-the-bed test" or "eyeball test" into their clinical decision making. However, over the last decade, numerous nonspecific and specific tools have emerged. The current evidence supports the use of a combination of simple, user-friendly, objective measures to first identify frailty in ESLD (notably Clinical Frailty Scale, Liver Frailty Index), followed by a combination of serial tools to assess specifically sarcopenia (i.e., muscle ultrasound), physical function (i.e., chair stands, hand grip strength), functional capacity (i.e., 6-minute walk test), and physical disability (i.e., activities of daily living).
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Affiliation(s)
- Felicity R Williams
- National Institute for Health Research Biomedical Research CenterInstitute of Inflammation and AgeingUniversity of BirminghamBirminghamUnited Kingdom.,Liver Transplant UnitQueen Elizabeth University Hospital BirminghamBirminghamUnited Kingdom
| | - Don Milliken
- Department of AnesthesiologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Jennifer C Lai
- Division of Gastroenterology and HepatologyDepartment of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Matthew J Armstrong
- Liver Transplant UnitQueen Elizabeth University Hospital BirminghamBirminghamUnited Kingdom.,National Institute for Health Research Biomedical Research CenterCenter for Liver ResearchUniversity of BirminghamBirminghamUnited Kingdom
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Duarte-Rojo A, Bloomer PM, Rogers RJ, Hassan MA, Dunn MA, Tevar AD, Vivis SL, Bataller R, Hughes CB, Ferrando AA, Jakicic JM, Kim WR. Introducing EL-FIT (Exercise and Liver FITness): A Smartphone App to Prehabilitate and Monitor Liver Transplant Candidates. Liver Transpl 2021; 27:502-512. [PMID: 37160036 DOI: 10.1002/lt.25950] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022]
Abstract
Preserved physical function is key for successful liver transplantation (LT); however, prehabilitation strategies are underdeveloped. We created a smartphone application (app), EL-FIT (Exercise and Liver FITness), to facilitate exercise training in end-stage liver disease (ESLD). In this feasibility study, we tested EL-FIT app usage and the accuracy of physical activity data transfer and obtained feedback from initial users. A total of 28 participants used the EL-FIT app and wore a physical activity tracker for 38 ± 12 days (age, 60 ± 8 years; 57% males; Model for End-Stage Liver Disease-sodium, 19 ± 5). There was fidelity in data transfer from the tracker to the EL-FIT app. Participants were sedentary (1957 [interquartile range, 873-4643] steps/day) at baseline. Level of training assigned by the EL-FIT app agreed with that from a physical therapist in 89% of cases. Participants interacted with all app features (videos, perceived exertion, and gamification/motivational features). We rearranged training data to generate heart rate-validated steps as a marker of performance and showed that 35% of the participants had significant increases in their physical performance. Participants emphasized their interest in having choices to better engage in exercise, and they appreciated the sense of community the EL-FIT app generated. We showed that patients with ESLD are able to use and interact with the EL-FIT app. This novel smartphone app has the potential of becoming an invaluable tool for home-based prehabilitation in LT candidates.
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Affiliation(s)
- Andrés Duarte-Rojo
- Division of Gastroenterology, Hepatology and Nutrition, Thomas E. Starzl Transplantation Institute, Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Liver Transplantation Program, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Pamela M Bloomer
- Liver Transplantation Program, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Renee J Rogers
- Healthy Lifestyle Institute, University of Pittsburgh School of Education, Pittsburgh, PA
| | - Mohamed A Hassan
- Division of Gastroenterology, Hepatology and Nutrition, Thomas E. Starzl Transplantation Institute, Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael A Dunn
- Division of Gastroenterology, Hepatology and Nutrition, Thomas E. Starzl Transplantation Institute, Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Liver Transplantation Program, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amit D Tevar
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Samantha L Vivis
- Division of Gastroenterology, Hepatology and Nutrition, Thomas E. Starzl Transplantation Institute, Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology and Nutrition, Thomas E. Starzl Transplantation Institute, Pittsburgh Liver Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Liver Transplantation Program, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christopher B Hughes
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Arny A Ferrando
- Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR
| | - John M Jakicic
- Healthy Lifestyle Institute, University of Pittsburgh School of Education, Pittsburgh, PA
| | - W Ray Kim
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA
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Marasco G, Dajti E, Ravaioli F, Brocchi S, Rossini B, Alemanni LV, Peta G, Bartalena L, Golfieri R, Festi D, Colecchia A, Renzulli M. Clinical impact of sarcopenia assessment in patients with liver cirrhosis. Expert Rev Gastroenterol Hepatol 2021; 15:377-388. [PMID: 33196344 DOI: 10.1080/17474124.2021.1848542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Sarcopenia is defined as loss of skeletal muscle mass, strength, and function, and it is associated with increased morbidity and mortality in patients with chronic liver disease.Areas covered: The aim of this review is to provide a detailed report on the pathophysiological mechanisms underlying sarcopenia in cirrhotic patients, the several imaging methods available for the assessment of sarcopenia and the clinical studies evaluating the prognostic role of sarcopenia presence in cirrhotic patients.Expert opinion: Sarcopenia pathogenesis is complex and multifaceted, as chronic catabolic conditions, increased energy expenditure, reduced appetite, side effects of multiple therapies, alterations in circulating levels of hormones, low protein synthesis, presence of ascites or portosystemic shunts are all factors contributing to muscle atrophy in cirrhotic patients. Computed tomography scan is the most validated method to evaluate muscle mass and quality. Sarcopenia is associated with a higher rate waitlist mortality, hepatic encephalopathy, and lower quality of life in patients with liver cirrhosis. Future studies should make an effort to unify and validate liver disease-specific cutoffs for the definition of sarcopenia.
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Affiliation(s)
- Giovanni Marasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elton Dajti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Stefano Brocchi
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Benedetta Rossini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Giuliano Peta
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Laura Bartalena
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Matteo Renzulli
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
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Exercise Capacity and Functional Status in Liver Transplant Candidates: Identifying perceived determinants and consequences. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.884024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ross E, Wright H, Villani A. Lower body extremity function is associated with health-related quality of life: a cross-sectional analysis of overweight and obese older adults with and without type 2 diabetes mellitus. Qual Life Res 2021; 30:2265-2273. [PMID: 33745064 DOI: 10.1007/s11136-021-02821-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE We aimed to explore the relationship between characteristics of the sarcopenic phenotype and health-related quality of life (HRQoL) in community-dwelling overweight and obese older adults with and without type 2 diabetes mellitus (T2DM). METHODS Appendicular lean mass (ALM), corrected for height (ALM/m2) was assessed by dual-energy X-ray absorptiometry. Muscle strength was assessed using handgrip strength (HGS), and lower extremity physical function was assessed using the Short Performance Physical Battery (SPPB) and gait speed. HRQoL was determined using the short-form 36 (SF-36) survey. Multiple regression analysis was used to examine the association between characteristics of the sarcopenic phenotype and domains of HRQoL. RESULTS A total of n = 152 community-dwelling older adults were included (T2DM cohort: n = 87, 71.2 ± 8.2 years, BMI: 29.5 ± 5.9 kg/m2; Obese cohort: n = 65, 68.7 ± 5.6 years, BMI: 33.7 ± 4.9 kg/m2). After adjusting for potential confounders, gait speed and SPPB were positively associated with the physical function subscale of HRQoL (Gait speed: ß = 0.658; P < 0.001; SPPB: ß = 0.478; P < 0.001). This relationship was also maintained for gait speed when assessed independently by cohort (T2DM cohort: ß = 0.637; P < 0.001; Obese cohort: ß = 0.507; P = 0.003). CONCLUSIONS Our results further contribute to the literature suggesting that lower body extremity function is associated with the physical function subscale of HRQoL. However, larger longitudinal data are required to assess whether lower body extremity function is independently associated with HRQoL, which includes the potential impact of nutrition and physical activity status.
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Affiliation(s)
- Emily Ross
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, 4558, Australia
| | - Hattie Wright
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, 4558, Australia
| | - Anthony Villani
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, 4558, Australia.
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Sciarrone SS, Zanetto A, Russo FP, Germani G, Gambato M, Battistella S, Pellone M, Shalaby S, Burra P, Senzolo M. Malnourished cirrhotic patient: what should we do? Minerva Gastroenterol (Torino) 2021; 67:11-22. [PMID: 33784807 DOI: 10.23736/s2724-5985.20.02776-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Malnutrition and sarcopenia have a high prevalence in cirrhotic patients. Frailty generally overlaps with malnutrition and sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition in cirrhosis is complex and multifactorial and it is not just due to reduction in protein and calorie intake. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched-chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality- and liver-related events, these latter and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long-term ammonia-lowering agents and myostatin antagonists, are currently under investigation. Malnutrition, sarcopenia and frailty are unique, inter-related and multidimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.
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Affiliation(s)
- Salvatore S Sciarrone
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Alberto Zanetto
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Francesco P Russo
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Giacomo Germani
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Martina Gambato
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Sara Battistella
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Monica Pellone
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Sarah Shalaby
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Marco Senzolo
- Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy -
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Systematic review and meta-analysis of lean mass and mortality: Rationale and study description. Osteoporos Sarcopenia 2021; 7:S3-S12. [PMID: 33997303 PMCID: PMC8088993 DOI: 10.1016/j.afos.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/26/2020] [Accepted: 01/26/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives Muscle mass is one of the key components in defining sarcopenia and is known to be important for locomotion and body homeostasis. Lean mass is commonly used as a surrogate of muscle mass and has been shown to be associated with increased mortality. However, the relationship of lean mass with mortality may be affected by different clinical conditions, modalities used, cut-off point to define low or normal lean mass, and even types of cancer among cancer patients. Thus, we aim to perform a comprehensive meta-analysis of lean mass with mortality by considering all these factors. Methods Systematic search was done in PubMed, Cochrane Library and Embase for articles related to lean mass and mortality. Lean mass measured by dual X-ray absorptiometry, bioelectrical impedance analysis, and computerized tomography were included. Results The number of relevant studies has increased continuously since 2002. A total of 188 studies with 98 468 people were included in the meta-analysis. The association of lean mass with mortality was most studied in cancer patients, followed by people with renal diseases, liver diseases, elderly, people with cardiovascular disease, lung diseases, and other diseases. The meta-analysis can be further conducted in subgroups based on measurement modalities, site of measurements, definition of low lean mass adopted, and types of cancer for studies conducted in cancer patients. Conclusions This series of meta-analysis provided insight and evidence on the relationship between lean mass and mortality in all directions, which may be useful for further study and guideline development.
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Abstract
Greater than half of patients with decompensated liver disease suffer from frailty and/or sarcopenia, which can lead to increased pre- and post-liver transplant morbidity and mortality. Although frailty and sarcopenia can impact patients with end-stage liver disease in similar ways, they are unique clinical entities with differing underlying etiologies. Early assessment and identification of frailty and sarcopenia in patients is critical to guide clinical decision-making regarding transplantation and to implement nutritional and exercise-based treatment regiments. Nonetheless, accurate diagnosis and, in particular, predicting patients that will develop frailty and/or sarcopenia remains challenging, and the success of clinical interventions is limited.
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Nawawi A, Justine M, Mazzuin Razali R. Quality of life, hospitalisation and sarcopenia among the elderly: a systematic review. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
OBJECTIVES: Frailty is prevalent in patients with cirrhosis and is hypothesized to result in part from sarcopenia, but the precise contribution of sarcopenia to frailty in this population is poorly understood. METHODS: Included were patients with cirrhosis from 2011 to 2014 who had an ambulatory frailty assessment and abdominal computed tomography scan within 3 months. Logistic regression assessed the associations between frailty (=Liver Frailty Index ≥4.5), and sarcopenia (=skeletal muscle index of <39 cm2/m2 for women and <50 cm2/m2 for men). RESULTS: Two hundred ninety-one participants were included: 33% were female. The median (interquartile range) Liver Frailty Index was 3.7 (3.3–4.2); 19% were frail. The median (interquartile range) skeletal muscle index was 49 cm2/m2 (31–69); 36% had sarcopenia. Among the 54 frail participants, 48% had sarcopenia. In univariable logistic regression, sarcopenia was associated with a 1.86× increased odds of being frail (95% confidence interval [CI], 1.02–3.38). After adjusting for sex, etiology, hepatocellular carcinoma, MELDNa, ascites, encephalopathy, and hypertension, sarcopenia was associated with a 2.38× increased odds of being frail (95% CI, 1.17–4.85). After stratifying by sex and adjusting for MELDNa, sarcopenia among males was associated with a significantly increased odds of frailty (odds ratio 2.81, 95% CI, 1.19–6.67), whereas sarcopenia among females was not (odds ratio 1.38; 95% CI, 0.45–4.25). DISCUSSION: In patients with cirrhosis, sarcopenia was associated with a nearly 2-fold increased odds of being frail. Two-thirds of frail men displayed sarcopenia compared with only one-quarter of frail women. Contributors to the frail phenotype may differ by sex and support the need for sex-specific strategies to reduce frailty in this population.
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DuBrock HM, Krowka MJ, Krok K, Forde K, Mottram C, Scanlon P, Al-Naamani N, Patel M, McCormick A, Fallon MB, Kawut SM. Prevalence and Impact of Restrictive Lung Disease in Liver Transplant Candidates. Liver Transpl 2020; 26:989-999. [PMID: 32394590 PMCID: PMC8845077 DOI: 10.1002/lt.25794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 01/19/2023]
Abstract
We investigated the prevalence of spirometric restriction in liver transplantation (LT) candidates and the clinical impacts of restriction. We performed a cross-sectional study within the Pulmonary Vascular Complications of Liver Disease 2 (PVCLD2) study, a multicenter prospective cohort study of patients being evaluated for LT. Patients with obstructive lung disease or missing spirometry or chest imaging were excluded. Patients with and without restriction, defined as a forced vital capacity (FVC) <70% predicted, were compared. Restriction prevalence was 18.4% (63/343). Higher Model for End-Stage Liver Disease-sodium score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.11; P = 0.007), the presence of pleural effusions (OR, 3.59; 95% CI, 1.96-6.58; P < 0.001), and a history of ascites (OR, 2.59; 95% CI, 1.26-5.33; P = 0.01) were associated with the presence of restriction, though one-third with restriction had neither pleural effusions nor ascites. In multivariate analysis, restriction was significantly and independently associated with lower 6-minute walk distances (least squares mean, 342.0 [95% CI, 316.6-367.4] m versus 395.7 [95% CI, 381.2-410.2] m; P < 0.001), dyspnea (OR, 2.69; 95% CI, 1.46-4.95; P = 0.002), and lower physical component summary Short Form 36 scores indicating worse quality of life (least squares mean, 34.1 [95% CI, 31.5-36.7] versus 38.2 [95% CI, 36.6-39.7]; P = 0.004). Lower FVC percent predicted was associated with an increased risk of death (hazard ratio, 1.16; 95% CI, 1.04-1.27 per 10-point decrease in FVC percent predicted; P = 0.01). Restriction and abnormal lung function are common in LT candidates; can be present in the absence of an obvious cause, such as pleural effusions or ascites; and is associated with worse exercise capacity, quality of life, and survival.
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Affiliation(s)
- Hilary M. DuBrock
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael J. Krowka
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karen Krok
- Division of Gastroenterology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Kimberly Forde
- Center for Clinical Epidemiology and Biostatistics and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carl Mottram
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Paul Scanlon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Nadine Al-Naamani
- Center for Clinical Epidemiology and Biostatistics and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mamta Patel
- Center for Clinical Epidemiology and Biostatistics and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Amber McCormick
- Center for Clinical Epidemiology and Biostatistics and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Steven M. Kawut
- Center for Clinical Epidemiology and Biostatistics and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Sempokuya T, Yokoyama-Arakaki L, Wong LL, Kalathil S. A Pilot Study of Racial Differences in the Current Definition of Sarcopenia among Liver Transplant Candidates. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:161-167. [PMID: 32432222 PMCID: PMC7226313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sarcopenia has been shown to have prognostic value in patients awaiting liver transplant. However, the presence of sarcopenia as a prognostic factor among patients awaiting liver transplantation might vary by race. This study aims to assess racial differences of sarcopenia in liver transplant candidates. This retrospective study assessed 102 patients on a liver transplantation list from 2012 to 2016 and used demographic and clinical variables to predict sarcopenia as measured by skeletal muscle index (SMI) and death or removal from the transplant list. Three racial groups were compared in the study: whites (n=34), Asians (n=50), and Native Hawaiians and Other Pacific Islanders (NHOPIs; n=18). NHOPI were more likely to have a body mass index (BMI) ≥ 30 and hepatitis B, and less likely to have alcoholic cirrhosis and sarcopenia than whites. Asians were more likely to have hepatitis B and less likely to have alcoholic cirrhosis and encephalopathy than other races. Using logistic regression, a BMI ≥ 30, multiple waiting list events, alcoholic cirrhosis, and sarcopenia were predictive of death or removal from the list. Although NHOPI had a higher BMI, they had less sarcopenia and similar frequency of ascites, encephalopathy, multiple waiting list events, and death or removal from the list compared to other races. Racial variations in muscle mass might have resulted in fewer NHOPI having sarcopenia as defined by the US criteria. Larger studies of patients with varying ethnicity are needed to develop a universally applicable definition of sarcopenia before we use this for liver transplant listing or allocation.
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Affiliation(s)
- Tomoki Sempokuya
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (TS, SK)
| | | | - Linda L. Wong
- Transplant Center, The Queen's Medical Center, Honolulu, HI (LY-A, LLW)
| | - Sumodh Kalathil
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (TS, SK)
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Zambrano DN, Xiao J, Prado CM, Gonzalez MC. Patient-Generated Subjective Global Assessment and Computed Tomography in the assessment of malnutrition and sarcopenia in patients with cirrhosis: Is there any association? Clin Nutr 2020; 39:1535-1540. [DOI: 10.1016/j.clnu.2019.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/25/2022]
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Abstract
BACKGROUND AND AIM Body composition has emerged as a prognostic factor for end-stage liver disease. We therefore investigated muscle mass, body fat and other clinical-pathological variables as predictors of posttransplant survival. METHODS A total of 368 patients, who underwent orthotopic liver transplantation (OLT) at our institution, were assessed prior to OLT and followed for a median of 9.0 years (range 2.0-10.0 years) after OLT. Psoas, erector spinae and the combined paraspinal muscle area, as well as the corresponding indices normalized by body-height squared, were quantified by a lumbar (L3) cross-sectional computed tomography. In addition, absolute body fat and bone density were estimated by the same computed tomography approach. RESULTS Paraspinal muscle index (PSMI) (hazard ratio 0.955, P = 0.039) and hepatitis C (hazard rati 1.498, P = 0.038) were independently associated with post-OLT mortality. In contrast, body fat and bone density did not significantly affect post-OLT outcome (P > 0.05). The PSMI also predicted one-year posttransplant mortality with a receiver operating characteristics-area under the curve of 0.671 [95% confidence interval (CI) 0.589-0.753, P < 0.001) in male patients and outperformed individual psoas and erector spinae muscle group assessments in this regard. In male patients, a defined PSMI cutoff (<18.41 cm/m) was identified as suitable determinant for sarcopenia and posttransplant one-year mortality. In female OLT-recipients, however, sarcopenia was not predictive for patient survival und a women-specific cutoff could not be derived from this study. CONCLUSIONS Taken together this analysis provides evidence, which PSMI is a relevant marker for muscle mass and that sarcopenia is an independent predictor of early post-OLT survival in male patients.
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Oey RC, Aarts P, Erler NS, Metselaar HJ, Lakenman PL, Riemslag Baas-van der Ree S, van Kemenade MC, van Buuren HR, de Man RA. Identification and prognostic impact of malnutrition in a population screened for liver transplantation. Clin Nutr ESPEN 2020; 36:36-44. [DOI: 10.1016/j.clnesp.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
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Ney M, Li S, Vandermeer B, Gramlich L, Ismond KP, Raman M, Tandon P. Systematic review with meta-analysis: Nutritional screening and assessment tools in cirrhosis. Liver Int 2020; 40:664-673. [PMID: 31571398 DOI: 10.1111/liv.14269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/09/2019] [Accepted: 09/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Disease-related malnutrition is common in cirrhosis. Multiple studies have evaluated nutritional screening tools (NSTs, rapid bedside tests targeting who needs assessment) and nutritional assessment tools (NATs, used in diagnosing malnutrition) as predictors of clinical outcome in this population. We performed a systematic review and meta-analysis of this literature with the aim of summarising the varying definitions of malnutrition across studies, the available evidence for NSTs and the ability of NSTs and NATs to predict clinical outcomes in cirrhosis. METHODS The primary outcome measures were pre- and post-transplant mortality with a range of secondary outcomes. Inclusion: cirrhosis over age 16. Exclusion: >25% with hepatocellular carcinoma, primarily laboratory test-based NATs or lack of screening, assessment or outcome criteria. RESULTS Eight thousand eight hundred fifty patients were included across 47 studies. Only 3 studies assessed NSTs. Thirty-two definitions for malnutrition were utilised across studies. NATs predicted pre-transplant mortality in 69% of cases that were assessed with a risk ratio (RR) of 2.38 (95% CI 1.96-2.89). NATs were prognostic for post-transplant mortality only 28% of the times they were assessed, with a RR of 3.04 (95% CI 1.51-6.12). CONCLUSIONS The cirrhosis literature includes limited data on nutrition screening and multiple definitions for what constitutes malnutrition using NATs. Despite this discordance, it is clear that malnutrition is a valuable predictor of pre-transplant mortality almost regardless of how it is defined. We require clinical and research consensus around the definition of malnutrition and the accepted processes and cut-points for nutrition screening and assessment in cirrhosis.
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Affiliation(s)
- Michael Ney
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Suqing Li
- Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, AB, Canada
| | - Leah Gramlich
- Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kathleen P Ismond
- Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Puneeta Tandon
- Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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