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Molwitz I, Recklies F, Stark M, Horvatits T, Salamon J, Huber S, Fischer L, Adam G, Lohse AW, Sterneck M, Horvatits K. Muscle quality determined by computed tomography predicts short-term and long-term survival after liver transplantation. Sci Rep 2023; 13:7631. [PMID: 37165039 PMCID: PMC10172199 DOI: 10.1038/s41598-023-33349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
Sarcopenia, the loss of muscle mass and quality, contributes to worse clinical outcome in patients with end-stage liver disease, but its impact on short- and long-term survival remains insufficiently understood. The aim of this study was to evaluate the development of computed tomography (CT) muscle parameters and their impact on short-term and long-term survival after liver transplantation. This retrospective study included patients with liver transplantation between 2011 and 2015 and a pre-transplant CT scan. Clinical characteristics, CT muscle mass and density were assessed pre-transplant, and in available CT scans at short-term (11 months) and long-term follow-up (56 months). Overall, 93/152 (61%) patients (109 male, 55 ± 10 years) suffered from sarcopenia pre-transplant. In short- (n = 50) and long-term follow-up (n = 52) the muscle mass (- 2.65 cm2/m2 95% CI [- 4.52, - 0.77], p = 0.007; - 2.96 cm2/m2 [- 4.7, - 1.23], p = 0.001, respectively), and muscle density (- 3 HU [- 6, - 1], p = 0.007; - 2 HU [- 4, 0], p = 0.069) decreased. Myosteatosis was associated with a higher post-transplant mortality (survival probability: 3 months 72% vs. 95%, 1 year 63% vs. 90%, 5 years 54% vs. 84%, p = 0.001), while muscle mass was not. In conclusion, muscle mass and quality did not improve after transplant. Muscle quality predicts short- and long-term survival and could help to identify a patient's risk profile.
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Affiliation(s)
- Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Franziska Recklies
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horvatits
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Samuel Huber
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Lutz Fischer
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martina Sterneck
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karoline Horvatits
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Casirati A, Crotti S, Raffaele A, Caccialanza R, Cereda E. The use of phase angle in patients with digestive and liver diseases. Rev Endocr Metab Disord 2023; 24:503-524. [PMID: 36745355 DOI: 10.1007/s11154-023-09785-6] [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] [Accepted: 01/05/2023] [Indexed: 02/07/2023]
Abstract
Diseases of the liver and the digestive system can lead to malnutrition through an action of reduced food intake or nutrient use, inflammation and impaired metabolism, which result in substantial changes in body composition. Frequently, malnutrition manifests itself with weight loss and reduced muscle mass. However, weight loss and body mass index lack sensitivity to detect the loss of muscle mass and are not informative in distinguishing body water compartments and in characterizing their distribution. This issue is particularly relevant to these two disease models, which are frequently associated with fluid volume imbalances. Phase angle is a useful indicator for cell membrane integrity, water distribution between the intracellular and extracellular spaces and prediction of body cell mass as it is described by measured components of electrical impedance. Malnutrition, inflammation and oxidative stress impair electric tissue properties leading to lower values of PhA. In patients with inflammatory bowel and liver diseases, PhA was consistently found to be related to nutritional status and body composition, particularly the depletion of lean body mass and sarcopenia. It has been associated with prognosis, disease stage and severity and found to be helpful in monitoring fluid shifts and response to interventions.
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Affiliation(s)
- Amanda Casirati
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Silvia Crotti
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Caccialanza
- Pediatric Surgery Unit, Department of Maternal and Child Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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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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MURGOCI N. The importance of body composition assessment in the rehabilitation process. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. This personal study provides several aspects of the importance of body composition assessment in rehabilitation process in order to manage fat mass (FM), fat-free mas imbalances (FFM), pre-sarcopenia status, sarcopenia and risks association and to improve global functionality. Health outcomes and risk estimations regarding fat mass and skeletal muscle mass (SMM) plays a major role and should be integrated into the rehabilitation process routine in order to avoid functional impairment and physical disability by applying specific kinetic programs. Material and method. A number of 14 subjects classified as outpatients who have received physical therapy at home- kinesiotherapy for post-fracture / dislocation status of the lower limbs in accordance with the medical recommendations and legislation in force. At the end of the rehabilitation phase, the body composition was measured using bio impedance in order to adjust the next step of the active rehabilitation. The measurements were obtained with a completely bioelectrical impedance analyzer (BIA). Single frequency BIA (SF-BIA) was used. For each subject major body compartments determined as FFM (including bone mineral tissue, total body water-TBW and visceral protein), SMM and FM were measured as a tissue-system by means of linear empirical equations stored in the system memory together with personal physical data. IBM SPSS software version 25 was used for statistical analysis. Results and discussions. Four age groups determined as follows: 21.43% for 18-39 years, 50-69 years, >70 years each and 35.71% for 40-49 years, based on the rate of muscle loss, because its integrity is essential for rehabilitation program. From the 14 subjects there are 57.14 % men and 42.86% women, from urban environment 78.57% and rural 21.43%. Mean Age is 48.79 years ± 18.792 Std. Deviation. Fat mass from BIA recorded 21.43% cases low and normal each, and high/very high 57.14% of total cases. Consequently, of BMI (body mass index) association, 57.14% are at normal weight, 35.71% overweight and with obesity and 7.14% underweight. One Sample Chi-Square test applied to BMI Type Associate with FM reveals the statistical significance, < .05(.014). Fat-free mass index (FFMI), fat mass index (FMI), skeletal mass index (SMI) were computed by adjusted with height square. FMI somatotype components results are 64.3% adipose cases, 21.4% intermediate and 14.3% lean. One Sample Chi-Square test applied to FMI Types reveals the statistical significance < .05(.046). Regression equation of standard BMI and FMI with scatter plots for 77.8% of cases was computed in the present study. FFMI somatotype components recorded 57.1% intermediate cases, 21.4% slender and solid each. Regression equation of standard BMI and FFMI with scatter plots for 57.4% of cases was computed. Three patients exceeded 15 seconds at the chair stand test so probable sarcopenia was identified. From BIA were extracted the value for the skeletal mass and SMI was calculated by height adjusted: 13 (92.86%) cases have normal values and one (7.14%) case have optimal value. Regression equation of standard BMI and SMI with scatter plots for 66.4% of cases was computed. Pearson correlation (CI =99%) denotes strong statistical relationship between BMI and FMI (r=0.882), FFMI (r=0.815), Age (r=0.659), Water (r=-0.693). FMI also correlates strongly with Age (r= 0.707), Water (r=-0.925) and Proteins values (r=-0.819). FFMI also correlates strongly with SMI (r=0.984). Water correlates with Protein (r=0.848, CI = 99%). Beta regression analysis strongly correlates SMI prediction with FFMI (ß=0.731), Water (ß=0.138) and Protein (ß=-0.370) for p<0.05. Anova significance of .000 (CI=99%) with applicability of 99.8% of the cases (R2 =0.998) proved that constant predictors: Water (%), FFMI, Proteins (%), FMI, BMI interact to influence SMM variability. 64.25% of subjects recorded an insufficient water level and 71.43% of subjects recorded an insufficient proteins level. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up and the strongest point of BIA is the possibility to replace invasive laboratory analysis with a quick, noninvasive test that can be carried out in a medical office. Body composition evaluation should be performed at the different stages of the disease, during the course of treatments and the rehabilitation phase. Conclusions. For each patient specific kinetic program will be developed. FMI increase (64.3% adipose cases) denotes the risk of metabolic syndrome and insulin resistance. Consequently, resistive and concentric exercises will be applied. For FFMI loss (57.1% intermediate cases, 21.4% slender) and SMI increasing (92.86% cases have normal values but not optimal ones, 21.43% pre-sarcopenia detected by positive chair test) resistance, eccentric/concentric exercises should be applied. All kinetic programs will be preceded by warm-up and followed by stretching taking into account cardiac reserve for each patient. Maximal/sub-maximal force exercises will be used age-related. Additional water (64.25% of subjects recorded an insufficient water level) and proteins levels (71.43% of subjects recorded an insufficient proteins level) must be balanced by nutritional support in accordance with rehabilitation consult and current physician approval in the interdisciplinary team. BIA may be an important supporting tool for health professionals in order to customize the rehabilitation programs for each patient.
Keywords: body composition, rehabilitation, bioelectrical impedance, fat-free mass index, fat mass index, skeletal muscle index,
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Affiliation(s)
- Nicolae MURGOCI
- “Dunărea de Jos” University, Faculty of Physical Education and Sports, Galați, Romania
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Perteet-Jackson AD, Earthman CP, Price KL, Hanson A, Shyne MP, Larson-Nath CM. Body composition assessment after pediatric liver transplant. JPEN J Parenter Enteral Nutr 2021; 46:172-179. [PMID: 33686654 DOI: 10.1002/jpen.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/20/2021] [Accepted: 03/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pediatric liver transplantation generally restores metabolic function; yet after transplantation, some children remain malnourished, have increased adiposity, and develop obesity. Measurement of body composition in the assessment of nutrition status could reduce adverse consequences in children. METHODS Anthropometric measurements, multiple-frequency bioelectrical impedance analysis, air displacement plethysmography, and ultrasound measurements were conducted on children recruited from the liver transplant program at the University of Minnesota Masonic Children's Hospital. A cross-sectional study was conducted to describe the quality of weight gain in post-liver transplant children between the ages of 2 and 17 years using multiple assessment tools (air displacement plethysmography, multiple-frequency bioelectrical impedance analysis, and ultrasound) and to determine whether multiple-frequency bioelectrical impedance analysis and ultrasound accurately describe body composition and quality of weight gain. RESULTS Mean percent body fat by air displacement plethysmography and multiple-frequency bioelectrical impedance analysis was 18.4% (±3.3) and 19.0% (±3.9), respectively (P > .99). There were insufficient data to examine the relationship between summed muscle and adipose thickness measures by ultrasound and percent body fat determined by air displacement plethysmography or multiple-frequency bioelectrical impedance analysis. CONCLUSION Percent body fat, fat mass, and fat-free mass measures determined by air displacement plethysmography and multiple-frequency bioelectrical impedance analysis were not statistically different, which suggests the stand-on device used in this study could be a useful body composition assessment tool for the pediatric population.
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Affiliation(s)
- Alissa D Perteet-Jackson
- Department of Food Science and Nutrition, University of Minnesota Twin Cities, St. Paul, Minnesota, USA
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
| | - Kathleen L Price
- Department of Nutrition, University of Tennessee Knoxville, Knoxville, Tennessee, USA
| | - Amy Hanson
- Department of Pediatrics, University of Minnesota Twin Cities, St. Paul, Minnesota, USA
| | - Michael P Shyne
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota Twin Cities, St. Paul, Minnesota, USA
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Hegyi PJ, Soós A, Hegyi P, Szakács Z, Hanák L, Váncsa S, Ocskay K, Pétervári E, Balaskó M, Eröss B, Pár G. Pre-transplant Sarcopenic Obesity Worsens the Survival After Liver Transplantation: A Meta-Analysis and a Systematic Review. Front Med (Lausanne) 2020; 7:599434. [PMID: 33392221 PMCID: PMC7772841 DOI: 10.3389/fmed.2020.599434] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/26/2020] [Indexed: 12/18/2022] Open
Abstract
Background: The rising prevalence of cirrhotic cases related to non-alcoholic steatohepatitis has led to an increased number of cirrhotic patients with coexistence of obesity and muscle mass loss, known as sarcopenic obesity (SO). In patients undergoing liver transplantation (LT), the presence of SO may worsen prognosis, and increase morbidity and mortality. Objective: We aimed to evaluate the effect of the presence of pre-transplant SO on the outcomes of LT. Methods: A comprehensive search was performed in seven medical databases for studies comparing morbidity and mortality of patients with and without SO after LT. The primary outcome was overall mortality in the short- (1 year), intermediate- (3 years), and long- (5 years) term. We calculated pooled relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was quantified with I2-statistics. Results: Based on the analysis of 1,515 patients from three articles, SO increased overall mortality compared to non-SO at short-, intermediate-, and long-term follow-up (RR = 2.06, 95% CI: 1.28-3.33; RR = 1.67, 95% CI: 1.10-2.51; and RR = 2.08, 95% CI: 1.10-3.93, respectively) without significant between-study heterogeneity for the short- and intermediate- term (I2 = 0.0% for both) and considerable heterogeneity for long-term follow-up (I2 = 81.1%). Conclusion: Pre-transplant SO proved to be a risk factor after LT and was associated with two times higher mortality at short- and long- term follow-up. Since SO worsens the prognosis of patients after LT, the inclusion of body composition assessment before LT may help to plan a more individualized nutritional treatment, physiotherapy, and postoperative care and may improve morbidity and mortality.
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Affiliation(s)
- Péter Jenö Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Soós
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary.,Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Lilla Hanák
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Klementina Ocskay
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Erika Pétervári
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Eröss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Gabriella Pár
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
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Perteet-Jackson AD, Earthman CP, Larson-Nath CM. Body Composition Post Pediatric Liver Transplant: Implications and Assessment. Nutr Clin Pract 2020; 36:1173-1184. [PMID: 33242232 DOI: 10.1002/ncp.10601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/17/2020] [Indexed: 12/30/2022] Open
Abstract
Liver disease has a negative influence on growth and development of children. Measurement of body composition as a component of nutrition status assessment in children before and after transplant would facilitate tailoring of nutrition therapy. A comprehensive literature search on pediatric liver transplant and body composition assessment was performed using a modified systematic approach. This review includes evidence specific to body composition of children undergoing liver transplant and a discussion of relevant body composition assessment methods for this population. Malnutrition is commonly seen in children with liver disease prior to transplant because of the disrupted metabolic pathways from liver dysfunction; however, malnutrition is not consistently diagnosed. Within 1 year of transplant, children tend to quickly recover with weight gain and linear growth. In some children, obesity and sarcopenia have been observed as long-term posttransplant outcomes. Body composition assessment tools have been utilized in diagnosing nutrition status in adults; yet there are limited studies that use these tools in the pediatric liver-transplant population. Technologies available to assess body composition include air displacement plethysmography, dual-energy x-ray absorptiometry, bioimpedance, and ultrasound. Total body potassium has been used for body composition assessment in adults and children post liver transplant; however, this method is not applicable in a clinical setting. We conclude that understanding posttransplant body composition could help clinicians diagnose and treat malnutrition.
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Affiliation(s)
- Alissa D Perteet-Jackson
- Department of Food Science and Nutrition, University of Minnesota-Twin Cities, St. Paul, Minnesota, USA
| | - Carrie P Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware, USA
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8
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Duarte I, Gameiro J, Resina C, Outerelo C. In-hospital mortality in elderly patients with acute kidney injury requiring dialysis: a cohort analysis. Int Urol Nephrol 2020; 52:1117-1124. [PMID: 32372303 DOI: 10.1007/s11255-020-02482-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine risk factors for in-hospital mortality in elderly patients with acute kidney injury (AKI) requiring dialysis. INTRODUCTION AKI requiring dialysis is frequent in elderly and is associated with an increased intra-hospital mortality. With the growing number of older individuals among hospitalized patients with AKI demands a thorough investigation of the factors that contribute to their mortality to improve outcomes. METHODS We performed a retrospective analysis of patients older than 80 years, admitted due to AKI requiring dialysis between January 2016 and December 2017. Patients who need intensive-care units (ICU) admission were excluded. The primary outcome was all-cause in-hospital mortality. RESULTS A total of 154 patients were evaluated. The mean age was 85.3 ± 4.0 years and 76 patients (49.4%) were male. The overall mortality rate was 26.6%. On the multivariate analysis, serum albumin (OR 0.42 [95% CI 0.21-0.85], p 0.016), C reactive protein/albumin ratio (OR 1.04 [95% CI 0.99-1.09], and renal function recovery (OR 018 [95% CI 0.49-0.65], p 0.009) were the factors associated with higher in-hospital mortality. CONCLUSIONS Lower albumin level, higher C reactive protein/albumin ratio at admission, and absence of renal function recovery are associated with increased in-hospital mortality's risk in elderly with acute kidney injury requiring dialysis.
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Affiliation(s)
- Inês Duarte
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Cristina Resina
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Cristina Outerelo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Universitário Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
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9
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Ingraham NE, Tignanelli CJ, Menk J, Chipman JG. Pre- and Peri-Operative Factors Associated with Chronic Critical Illness in Liver Transplant Recipients. Surg Infect (Larchmt) 2019; 21:246-254. [PMID: 31618109 DOI: 10.1089/sur.2019.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Chronic critical illness (CCI) is a new and increasing entity that accounts for substantial cost despite its low incidence. We hypothesized that patients with end-stage liver failure undergoing liver transplant would be at high risk for developing CCI. With limited liver donors it is essential to understand pre- and peritransplant predictors of CCI. Methods: To accomplish this we performed a retrospective cohort study at a large academic transplant center of all adult liver transplant patients from 2011 to 2017. We defined CCI as the need for mechanical ventilation for seven days or more post-transplant. Recipients who had re-transplantation during their index admission, acute rejection, or who died during transplant surgery were excluded. Logistic regression was performed using the Akaike information criterion (AIC) and the likelihood ratio test. Results: We identified 382 transplant recipients. Forty-five (11.8%) developed CCI. Univariable analysis identified 16 pre-transplant factors associated with post-transplant CCI. Subsequent multivariable logistic regression identified eight independent factors associated with CCI in liver transplant recipients including previous liver transplant, acute renal failure, frailty, lower albumin level, higher international normalized ratio, need for mechanical ventilation, and higher systolic pulmonary artery pressure. Pre-transplant factors associated with protection against CCI included higher Model for End-Stage Liver Disease (MELD) score. Conclusion: The incidence of CCI post-liver transplant is similar to the general population admitted to the intensive care unit. Pre-transplant factors associated with CCI can help identify at-risk patients, and furthermore, promote further research and interventions with the goal to decrease the incidence of CCI in the liver transplant recipients.
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Affiliation(s)
| | - Christopher J Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.,Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota.,Department of Surgery, North Memorial Health Hospital, University of Minnesota, Minneapolis, Minnesota
| | - Jeremiah Menk
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Jeffrey G Chipman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.,Division of Critical Care and Acute Care Surgery, University of Minnesota, Minneapolis, Minnesota
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Is phase angle an appropriate indicator of malnutrition in different disease states? A systematic review. Clin Nutr ESPEN 2018; 29:1-14. [PMID: 30661671 DOI: 10.1016/j.clnesp.2018.10.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/04/2018] [Accepted: 10/17/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Subjective Global Assessment (SGA) classifies malnutrition severity via a simple bedside assessment. Phase angle (PhA) is an indicator of cell integrity and has been suggested to be indicator of nutritional status. OBJECTIVE To explore the relationship between PhA and SGA. METHODS Relevant studies published through October 31, 2017 were identified using 7 electronic databases. Articles were included for review if they included comparison data between SGA and PhA within adult disease populations. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines and methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS 33 articles within four disease states (liver, hospitalization, oncology and renal) met inclusion criteria for review. Results were limited by restricting the database search to articles published in English only, and by the inherent difficulty of comparing 2 methods which are both influenced by the operator. CONCLUSION Based on GRADE guidelines, evidence quality received a grade of Low. Based on QUADAS-2, 61% of studies had high risk of bias in the index test (PhA), while all other domains had low risk. It is not possible to conclude that PhA is an accurate independent indicator of malnutrition. PROSPERO no. CRD42016050876.
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Tomás MT, Melo X, Mateus É, Gonçalves M, Barroso E, Santa-Clara H. A 5-Year Follow-Up of The Benefits of an Exercise Training Program in Liver Recipients Transplanted Due to Familial Amyloidotic Polyneuropathy. Prog Transplant 2018; 28:330-337. [PMID: 30261817 DOI: 10.1177/1526924818800033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Supervised (SE) and home-based exercise (HBE) training regimes are effective on reconditioning patients with familial amyloidotic polyneuropathy (FAP) after liver transplantation, but research of the long-term retention of the benefits attained in patients with FAP has not yet been conducted. PURPOSE In this 5-year follow-up study, we aimed to determine whether the exercise training gains in body composition, physical activity, and function promoted by a 24-week SE or HBE training regimes are retained in patients with FAP who resume normal activity. METHODOLOGY Sixteen liver-transplanted patients with FAP were reassessed for body composition (dual X-ray absorptiometry), physical activity (questionnaire), and function (handgrip strength and 6-minute walk test). RESULTS Total body fat increased with both exercise regimes during follow-up ( P < .05; η2 = 0.432-0.625) as well as femoral neck bone density ( P = .048; η2 = 0.119). However, gains in upper limbs muscle quality during follow-up ( P < .001; η2 = 0.597) were only found in the SE group ( P = .042; η2 = 0.245). Both exercise regimes showed retaining aptitudes in walking capacity ( P < .05; η2 = 0.329-0.460) and muscle mass ( P = .05; η2 = 0.245). Still, none could retain the physical activity levels. CONCLUSION Long-term resumption of normal activity following a 24-week SE or HBE regime in patients with FAP resulted in loss of exercise induced increases in physical activity but counterweighted postoperative losses in bone mineral density and substantially retained the benefits in walking capacity, muscle mass, and quality, in particular, in the SE group.
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Affiliation(s)
- Maria Teresa Tomás
- 1 Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) at Instituto Politécnico de Lisboa (IPL), Lisbon, Portugal.,2 Interdisciplinary Centre for the Study of Human Performance (CIPER) at Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Xavier Melo
- 2 Interdisciplinary Centre for the Study of Human Performance (CIPER) at Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal.,3 Ginásio Clube Português, Lisbon, Portugal
| | - Élia Mateus
- 4 Hepatobiliopancreatic and Transplantation Centre at Hospital Curry Cabral, Lisboa, Portugal
| | - Mafalda Gonçalves
- 2 Interdisciplinary Centre for the Study of Human Performance (CIPER) at Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Eduardo Barroso
- 4 Hepatobiliopancreatic and Transplantation Centre at Hospital Curry Cabral, Lisboa, Portugal
| | - Helena Santa-Clara
- 2 Interdisciplinary Centre for the Study of Human Performance (CIPER) at Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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Nomogram and Validity of a Model for Predicting Malnutrition in Patients on Liver Transplant Lists. Dig Dis Sci 2018; 63:1952-1961. [PMID: 29691779 DOI: 10.1007/s10620-018-5079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/16/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Malnutrition is associated with increased morbimortality in liver transplant patients, and it is important to identify factors related to nutritional status in these patients. AIMS Determine variables associated with malnutrition and create a nomogram in liver transplant candidates. METHODS Cross-sectional study (n = 110). VARIABLES demographic variables, imbalances due to the disease, transplant aetiology and analytical parameters. Physical examination was performed and degree of hepatic dysfunction calculated. Nutritional status was assessed: Controlling Nutritional Status, Spanish Society of Parenteral and Enteral Nutrition criteria, Nutritional Risk Index, Prognostic Nutritional Index or Onodera Index and The Subjective Global Assessment. Logistic regression analysis was performed. A predictive nomogram (discrimination and calibration analysis) was generated. RESULTS Malnourishment was defined according to at least 4 or more of the methods studied. Patients with ascites, encephalopathy and portal hypertension presented malnourishment more frequently. Malnutrition was associated with greater liver dysfunction and lower grip strength. Variables independently associated with malnourishment were encephalopathy and lower albumin values. A nomogram was created to predict malnourishment, with good discriminatory power and calibration. CONCLUSIONS A score was developed for evaluating malnutrition risk. This would provide a tool that makes it possible to quickly and easily identify the risk of malnutrition in liver transplant candidates.
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Yang J, Gao W, Zhan J, Feng J. Kasai procedure improves nutritional status and decreases transplantation-associated complications. Pediatr Surg Int 2018; 34:387-393. [PMID: 29368078 DOI: 10.1007/s00383-018-4228-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively investigate whether Kasai Procedure (KP) improves nutritional status and whether KP decreases liver transplantation (LT)-associated complications in children with biliary atresia (BA). METHODS From March 1st 2014 to February 28th 2015, 103 patients underwent LT and the other 17 without prior KP died during the waiting period. In 103 patients undergoing LT, 58 patients received KP previously (Group A), and 45 only underwent primary LT (Group B). The nutritional status, liver function and LT-related short-term complications were analyzed. RESULTS Compared to Group B, patients in Group A had significantly increased time interval when undergoing LT (p < 0.05). Persistently, the bodyweight, albumin and hemoglobin in Group A were significantly increased compared to Group B (all, p < 0.0001). The bilirubin, ALT/AST and PELD score in Group A were all decreased compared to Group B (p < 0.05) prior to LT. The incidences of post-LT severe infection and hypoalbuminemia in Group A were significantly lower than those of Group B (p < 0.05). CONCLUSIONS KP improves the nutritional status, preserves liver function for patients who finally undergo LT, and decreases the incidence post-LT severe infection and hypoalbuminemia. Mental health can be improved in parents whose children underwent previous KP.
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Affiliation(s)
- Jixin Yang
- Department of Pediatric Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Gao
- Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China
| | - Jianghua Zhan
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, China
| | - Jiexiong Feng
- Department of Pediatric Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Phase Angle Bioelectrical Impedance Analysis (BIA) as a Biomarker Tool for Liver Disease. BIOMARKERS IN DISEASE: METHODS, DISCOVERIES AND APPLICATIONS 2017. [DOI: 10.1007/978-94-007-7675-3_43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Fernandes SA, de Mattos AA, Tovo CV, Marroni CA. Nutritional evaluation in cirrhosis: Emphasis on the phase angle. World J Hepatol 2016; 8:1205-1211. [PMID: 27803765 PMCID: PMC5067440 DOI: 10.4254/wjh.v8.i29.1205] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/05/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Protein-calorie malnutrition (PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and non-anthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis (BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle (PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients’ overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner.
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Ehsani MJ, Mahdavi Jafari J, Aliasl J, Kamalinejad M, Gachkar L, Choopani R. Effect of diet based on the principles of Iranian traditional medicine on cirrhosis (a clinical trial). Complement Ther Med 2016; 29:35-41. [PMID: 27912954 DOI: 10.1016/j.ctim.2016.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 02/14/2016] [Accepted: 09/07/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Cirrhosis is associated with morbidity and mortality worldwide. Iranian traditional medicine (ITM) focused on nutritional intervention in order to improve liver function. The aim of this study was to assess the effectiveness of a diet designed based on ITM and current dietary recommendations. DESIGN This controlled trial study was performed on 57 subjects with cirrhosis in 5 tertiary hospitals in Teharn, Iran. SETTING Subjects were included if they were diagnosed with class A or B cirrhosis between October 2013 and December 2014. INTERVENTIONS Subjects were randomly allocated into intervention (28 subjects) who received dietary and lifestyle recommendations based on ITM and controls (29 subjects) who received routine dietary and lifestyle recommendations for 3 months. Subjects were assessed at baseline and at the end of the intervention for anthropometric measures, liver function tests and cirrhosis severity scoring. MAIN OUTCOME MEASURES Model for End-Stage Liver Disease (MELD), anthropometric measures, serum albumin, liver function tests, International Normalized Ratio and alkaline phosphatase as well as subjective findings. RESULTS Mean age of the subjects was 51.19±11.88years. Weight reduction was observed in 41 subjects (22 subjects in intervention and 19 in control group). Dietary intervention resulted in a significant decrease in alanine aminotransferase (AST) (p=0.04) and significant resolution of icterus in sclera (p=0.02) in weight loss group and increase serum albumin in weight gain group (p=0.02). CONCLUSIONS ITM recommendations could be beneficial for cirrhotic patients both for the purpose of weight reduction and weight gain.
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Affiliation(s)
- Mohammad Javad Ehsani
- Department of Gastroenterology and Hepatology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamileh Mahdavi Jafari
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jale Aliasl
- Traditional Medicine Clinical Trial Research Center, Shahid University, Tehran, Iran
| | - Mohammad Kamalinejad
- School of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Latif Gachkar
- Tropical and Infectious Diseases Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Rasool Choopani
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bakshi N, Singh K. Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant. Hepatobiliary Surg Nutr 2016; 5:358-71. [PMID: 27500148 PMCID: PMC4960422 DOI: 10.21037/hbsn.2016.03.09] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. METHODS We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. RESULTS Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage, blood loss during the surgery, BIA (fat mass, FFM, muscle mass and body fat%). CONCLUSIONS The different nutrition assessment tools showed great variability of results. SGA showed moderate agreement with phase angle of the body and was associated with various clinical and prognostic variables of liver transplantation.
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Affiliation(s)
- Neha Bakshi
- Department of Foods and Nutrition, Lady Irwin College, University of Delhi, New Delhi 110001, India
| | - Kalyani Singh
- Department of Foods and Nutrition, Lady Irwin College, University of Delhi, New Delhi 110001, India
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18
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Factors Associated With Changes in Body Composition Shortly After Orthotopic Liver Transplantation. Transplantation 2016; 100:1714-22. [DOI: 10.1097/tp.0000000000001202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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19
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Marroni CA, Miranda D, Boemeke L, Fernandes SA. Phase Angle Bioelectrical Impedance Analysis (BIA) as a Biomarker Tool for Liver Disease. BIOMARKERS IN DISEASE: METHODS, DISCOVERIES AND APPLICATIONS 2016:1-18. [DOI: 10.1007/978-94-007-7742-2_43-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
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20
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Kallwitz ER. Sarcopenia and liver transplant: The relevance of too little muscle mass. World J Gastroenterol 2015; 21:10982-10993. [PMID: 26494955 PMCID: PMC4607898 DOI: 10.3748/wjg.v21.i39.10982] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/09/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023] Open
Abstract
Loss of muscle mass and function is a common occurrence in both patients with decompensated cirrhosis and those undergoing liver transplantation. Sarcopenia is associated with morbidity and mortality before and after liver transplantation. The ability of skeletal muscle mass to recover after transplant is questionable, and long term adverse events associated with persistent sarcopenia have not been well studied. Limited data is available examining mechanisms by which decreased muscle mass might develop. It is not clear which interventions might reduce the prevalence of sarcopenia and associated health burdens. However, measures to either decrease portal hypertension or improve nutrition appear to have benefit. Research on sarcopenia in the liver transplant setting is hampered by differing methodology to quantify muscle mass and varied thresholds determining the presence of sarcopenia. One area highlighted in this review is the heterogeneity used when defining sarcopenia. The health consequences, clinical course and potential pathophysiologic mechanisms of sarcopenia in the setting of cirrhosis and liver transplantation are further discussed.
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Choudhary NS, Saigal S, Saraf N, Mohanka R, Rastogi A, Goja S, Menon PB, Mishra S, Mittal A, Soin AS. Sarcopenic obesity with metabolic syndrome: a newly recognized entity following living donor liver transplantation. Clin Transplant 2015; 29:211-5. [PMID: 25594826 DOI: 10.1111/ctr.12505] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There are limited data about sarcopenic obesity in liver transplant recipients. METHODS Living donor liver transplant recipients with at least 12 months of follow-up were included. Metabolic syndrome (MS) was defined as ≥ 3 ATP III criteria. Body composition was assessed by bioelectrical impedance. Immunosuppression protocol included short-term steroids, mycophenolate and calcineurin inhibitors (mainly tacrolimus). Data are shown as percentage, mean ± SD, or median (25-75 IQR). RESULTS The study comprised 82 patients (males 69), aged 50.5 ± 10.65 yr, and follow-up 24 (12-38.5) months. Etiology for cirrhosis was alcohol 29%, hepatitis C 22%, hepatitis B 17%, cryptogenic 24%, and others 7%. Post-transplant sarcopenic obesity was present in 72 (88%), and MS was present in 43 (52%) of recipients with no significant difference among etiologies. There were significant differences between pre- and post-transplant body mass index, triglycerides, high-density lipoprotein, low-density lipoprotein (p = 0.000 for all), prevalence of hypertension (18% vs. 39%), and diabetes (20% vs. 56%). Patients with sarcopenic obesity had significantly higher body mass index, waist circumference, and MS (57% vs. 20%, p = 0.041) when compared to patients without sarcopenic obesity. CONCLUSION Despite resuming routine activities, the majority of liver transplant recipients develop sarcopenic obesity and MS. The importance and role of appropriate nutrition and exercise after transplantation merits further investigation.
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Biolo G, Cederholm T, Muscaritoli M. Muscle contractile and metabolic dysfunction is a common feature of sarcopenia of aging and chronic diseases: From sarcopenic obesity to cachexia. Clin Nutr 2014; 33:737-48. [DOI: 10.1016/j.clnu.2014.03.007] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/17/2014] [Accepted: 03/24/2014] [Indexed: 12/18/2022]
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23
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Erb ED, Hand RK, Steiber AL. SGA Scores Have Poor Correlation With Serum Albumin in Obese Hemodialysis Patients: A Secondary Analysis. J Ren Nutr 2014; 24:268-71. [DOI: 10.1053/j.jrn.2014.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 11/11/2022] Open
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Tsien C, Garber A, Narayanan A, Shah SN, Barnes D, Eghtesad B, Fung J, McCullough AJ, Dasarathy S. Post-liver transplantation sarcopenia in cirrhosis: a prospective evaluation. J Gastroenterol Hepatol 2014; 29:1250-7. [PMID: 24443785 PMCID: PMC4024321 DOI: 10.1111/jgh.12524] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Pre-transplant sarcopenia (reduced skeletal muscle mass) predicts poor outcome in cirrhosis. In contrast, whether muscle mass increases post-orthotopic liver transplantation (OLT) is not known and was studied prospectively. METHODS Consecutive patients who underwent a comprehensive nutritional evaluation in a liver transplant nutrition clinic were included. Core abdominal muscle area was measured on abdominal computed tomography obtained pre- and post-OLT. Age- and gender-based controls were used to define sarcopenia. Measures of body composition pre-transplant were correlated with computed tomography measurements. Predictors and clinical impact of post-OLT change in muscle area were examined. In three subjects post-OLT and three controls, expression of genes regulating skeletal muscle mass were quantified. RESULTS During the study period, 53 patients (M:F 41:12; age 56.9 ± 7.5 years) were followed up after OLT for 19.3 ± 9 months. Five patients died and another five had acute graft rejection. Pre-OLT sarcopenia was present in 33 (66.2%). Pre-transplant clinical characteristics including Child's score, MELD score, and nutritional status or post-transplantation immunosuppression regimen did not predict post-transplant change in muscle mass. New onset post-OLT sarcopenia developed in 14 patients. Loss of muscle mass post-OLT increased risk of diabetes mellitus and a trend toward higher mortality. Skeletal muscle expression of myostatin was higher and that of ubiquitin proteasome proteolytic components lower post-OLT than in controls. CONCLUSIONS Post-transplantation sarcopenia is common and could not be attributed to pre-transplant characteristics or the type or duration of post-OLT immunosuppression. Post-transplant sarcopenia contributes to adverse consequences and strategies targeting myostatin may be beneficial.
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Affiliation(s)
- Cynthia Tsien
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland OH
| | - Ari Garber
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland OH
| | - Arvind Narayanan
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland OH
| | - Shetal N Shah
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland OH
| | - David Barnes
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland OH
| | - Bijan Eghtesad
- Department of Transplant Surgery, Cleveland Clinic, Cleveland OH
| | - John Fung
- Department of Transplant Surgery, Cleveland Clinic, Cleveland OH
| | - Arthur J McCullough
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland OH
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Prenner G, Wasler A, Fahrleinter-Pammer A, Werkgartner G, Mischinger HJ, Koter S, Roller R, Wagner D. The role of serum albumin in the prediction of malnutrition in patients at least five yr after heart transplantation. Clin Transplant 2014; 28:737-42. [DOI: 10.1111/ctr.12370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Günther Prenner
- Division for Transplantation; Department of Surgery; Medical University of Graz; Graz Austria
| | - Andrä Wasler
- Division for Transplantation; Department of Surgery; Medical University of Graz; Graz Austria
| | - Astrid Fahrleinter-Pammer
- Division for Endocrinology and Nuclear Medicine; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Georg Werkgartner
- Division for General Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Hans Jörg Mischinger
- Division for General Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Stephan Koter
- Division for Vascular Surgery; Department of Sugery; Medical University of Graz; Graz Austria
| | - Regina Roller
- Division for Geriatrics; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Doris Wagner
- Division for General Surgery; Department of Surgery; Medical University of Graz; Graz Austria
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Dasarathy S. Posttransplant sarcopenia: an underrecognized early consequence of liver transplantation. Dig Dis Sci 2013; 58:3103-11. [PMID: 23912247 PMCID: PMC4066193 DOI: 10.1007/s10620-013-2791-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/02/2013] [Indexed: 02/06/2023]
Abstract
Liver transplantation is believed to reverse the clinical and metabolic abnormalities of cirrhosis. Reduced skeletal muscle mass or sarcopenia contributes to increased mortality and adverse consequences of cirrhosis. Failure of reversal of sarcopenia of cirrhosis after liver transplantation is not well recognized. Six temporally, geographically, and methodologically distinct follow-up studies in 304 cirrhotics reported conflicting data on changes in indirect measures of skeletal muscle mass after transplantation. Distinct measures of body composition but not skeletal muscle mass were used and did not focus on the clinical consequences of sarcopenia after transplantation. A number of studies reported an initial rapid postoperative loss of lean mass followed by incomplete recovery with a maximum follow-up of 2 years. Posttransplant sarcopenia may be responsible for metabolic syndrome and impaired quality of life after liver transplantation. Potential reasons for failure to reverse sarcopenia after liver transplantation include use of immunosuppressive agents [mammalian target of rapamycin (mTOR) and calcineurin inhibitors] that impair skeletal muscle growth and protein accretion. Repeated hospitalizations, posttransplant infections, and renal failure also contribute to posttransplant sarcopenia. Finally, recovery from muscle deconditioning is limited by lack of systematic nutritional and physical-activity-based interventions to improve muscle mass. Despite the compelling data on sarcopenia before liver transplantation, the impact of posttransplant sarcopenia on clinical outcomes is not known. There is a compelling need for studies to examine the mechanisms and consequences of sarcopenia post liver transplantation to permit development of therapies to prevent and reverse this disorder.
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Affiliation(s)
- Srinivasan Dasarathy
- Department of Gastroenterology, Hepatology and Pathobiology, Cleveland Clinic, Lerner Research Institute, NE4 208, 9500 Euclid Avenue, Cleveland, OH, 44195, USA,
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Li G, Gao J, Liu ZG, Tao YL, Xu BQ, Tu ZW, Zhang XP, Zeng MS, Xia YF. Influence of pretreatment ideal body weight percentile and albumin on prognosis of nasopharyngeal carcinoma: Long-term outcomes of 512 patients from a single institution. Head Neck 2013; 36:660-6. [PMID: 23606535 DOI: 10.1002/hed.23357] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/29/2012] [Accepted: 04/09/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between pretreatment nutritional status and prognosis of nasopharyngeal carcinoma (NPC). METHODS Pretreatment nutritional status was evaluated by ideal body weight percentile (IBW%) and serum albumin for 512 patients with NPC who underwent radical radiotherapy. Kaplan-Meier methods, log-rank test, and a Cox model were applied for survival analysis. RESULTS Before radiotherapy, IBW% <90% was related to poorer overall survival (OS) and distant metastasis-free survival (DMFS; p = .031 and p = .012, respectively); albumin ≤43.0 g/L was related to poorer OS and DMFS (p < .001 and p = .042, respectively); both IBW% and albumin were independent prognostic factors for OS; those patients with IBW% <90% and albumin ≤43.0 g/L simultaneously had the worst OS and DMFS. CONCLUSION Decrease of pretreatment IBW% and albumin was related to poorer survival of NPC.
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Affiliation(s)
- Guo Li
- State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University, Guangzhou, People's Republic of China; Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China; Department of Radiation Oncology, Guangzhou Medical University Cancer Institute and Hospital, Guangzhou, People's Republic of China
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Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission. Clin Nutr 2012; 32:294-9. [PMID: 22921419 DOI: 10.1016/j.clnu.2012.08.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/26/2012] [Accepted: 08/01/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS This study determined the association between phase angle (PhA), by bioelectrical impedance analysis (BIA) and nutritional risk by Nutritional Risk Screening (NRS-2002), Subjective Global Assessment (SGA), hospital length of stay (LOS) and 30 day non-survival in patients at hospital admission compared to healthy controls. METHODS PhA was determined by BIA in patients (n = 983, 52.7 ± 21.5 yrs, M 520) and compared to healthy age-, sex- and height-matched controls. Low PhA was set at <5.0° (men) and <4.6° (women) as previously determined (Kyle, in press). RESULTS PhA was lower in patients (men 6.0 ± 1.4°, women 5.0 ± 1.3°) than controls (men 7.1 ± 1.2°, women 6.0 ± 1.2°, un-paired t-test p < 0.001). Patients were more likely to have low PhA than controls: NRS-2002: no risk (relative risk (RR) 1.7, 95th confidence interval (CI) 1.2-2.3), moderate risk (RR 4.5, CI 3.4-5.8) and severe risk (RR 7.5, CI 5.9-9.4); similar results were obtained by SGA; LOS ≥21 days (RR 6.9, CI 5.1-9.1) and LOS 5-20 days (RR 5.2, CI 3.9-6.9) and non-survivors (RR 3.1, CI 2.1-3.4) compared to survivors. CONCLUSIONS There is a significant association between low PhA and nutritional risk, LOS and non-survival. PhA is helpful to identify patients who are at nutritional risk at hospital admission in order to limit the number of in-depth nutritional assessments.
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Thibault R, Pichard C. The evaluation of body composition: a useful tool for clinical practice. ANNALS OF NUTRITION AND METABOLISM 2011; 60:6-16. [PMID: 22179189 DOI: 10.1159/000334879] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/07/2011] [Indexed: 12/22/2022]
Abstract
Undernutrition is insufficiently detected in in- and outpatients, and this is likely to worsen during the next decades. The increased prevalence of obesity together with chronic illnesses associated with fat-free mass (FFM) loss will result in an increased prevalence of sarcopenic obesity. In patients with sarcopenic obesity, weight loss and the body mass index lack accuracy to detect FFM loss. FFM loss is related to increasing mortality, worse clinical outcomes, and impaired quality of life. In sarcopenic obesity and chronic diseases, body composition measurement with dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or computerized tomography quantifies the loss of FFM. It allows tailored nutritional support and disease-specific therapy and reduces the risk of drug toxicity. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up of nutritional status. It could allow objective, systematic, and early screening of undernutrition and promote the rational and early initiation of optimal nutritional support, thereby contributing to reducing malnutrition-induced morbidity, mortality, worsening of the quality of life, and global health care costs.
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Affiliation(s)
- Ronan Thibault
- Centre de Recherche en Nutrition Humaine Auvergne, UMR 1019 Nutrition Humaine, INRA, Clermont Université, Service de Nutrition Clinique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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