ABSTRACT
Objective:To investigate the risk factors of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis, and to clarify the effect of sarcopenia on OHE.Methods:Based on the liver cirrhosis cohort established by our research group, from January 1, 2013 to December 31, 2017, 480 patients diagnosed with liver cirrhosis and underwent upper abdominal computed tomography were selected from 3 centers, including the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital), Shanghai East Hospital Affiliated to Tongji University, and Shandong Provincial Hospital. The L3 skeletal muscle index (L3-SMI) <44.77 cm 2/m 2 for males and L3-SMI <32.50 cm 2/m 2 for females were used as the diagnostic criterion for sarcopenia. The clinical data of all the patients were collected, including baseline medical history, age, serum total bilirubin, serum levels of aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), albumin, sodium, prothrombin time (PT), international normalized ratio (INR), hemoglobin, platelet count, etc, as well as Child-Pugh classification of liver function, and model for end-stage liver disease (MELD) score. Independent sample t test, rank sum test, and chi-square test were used for statistical analysis. Binary logistic regression analysis was used to analyze the independent risk factors for OHE in patients with liver cirrhosis, and Kaplan-Meier method was used to analyze the effect of sarcopenia on the incidence of OHE in patients with liver cirrhosis. Results:After 2 years of follow-up, the incidence of OHE was 16.2% (78/480). The age, serum total bilirubin level, AST, GGT, PT, INR, Child-Pugh score, and MELD score of OHE patients were all higher than those of non-OHE patients ((59.67±10.30) years old vs. (53.41±12.06) years old, 35.25 μmol/L(20.10 μmol/L, 60.53 μmol/L) vs. 22.70 μmol/L(15.10 μmol/L, 35.20 μmol/L), 40.00 U/L(27.25 U/L, 61.00 U/L) vs. 33.00 U/L(24.75 U/L, 47.00 U/L), 52.50 U/L(26.25 U/L, 86.75 U/L) vs. 34.50 U/L(22.00 U/L, 73.00 U/L), (17.71±3.52) s vs. (15.50±2.98) s, 1.50±0.34 vs. 1.31±0.29, 8.95±2.19 vs.7.20±1.94, 13.56±4.42 vs.11.42±3.92), while serum albumin, serum sodium and platelet count of OHE patients were all lower than those of non-OHE patients ((29.72±5.55) g/L vs. (33.19±5.89) g/L, 139.00 mmol/L(136.00 mmol/L, 142.00 mmol/L)vs.140.00 mmol/L (138.00 mmol/L, 142.00 mmol/L), 60.00×10 9/L(43.75×10 9/L, 90.25×10 9/L) vs. 80.00×10 9/L(56.00×10 9/L, 131.00×10 9/L)), and the differences were statistically significant ( t=-4.77; Z=-4.10, -3.13, -2.24; t=-5.19, -4.71, -6.57, -3.98, 4.99; and Z=2.44 and 3.48; all P<0.05). The proportions of ascites, hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis at baseline, and the incidence of sarcopenia in OHE patients were all higher than those in non-OHE patients (82.1%, 64/78 vs. 63.7%, 256/402; 41.0%, 32/78 vs. 3.5%, 14/402; 5.1%, 4/78 vs. 1.0%, 4/402; 14.1%, 11/78 vs. 2.5%, 10/402; 37.2%, 29/78 vs. 19.7%, 79/402), and the L3-SMI of OHE patients was lower than that of non-OHE patients ((43.14±8.97) cm 2/m 2 vs. (46.29±8.49) cm 2/m 2), and the differences were statistically significant ( χ2=9.11, 101.97, 4.52, 18.38, 10.53; t=2.86; all P<0.05). The results of binary logistic regression analysis indicated that platelet count ( OR=0.995, 95% confidence interval (95% CI) 0.991 to 1.000, P=0.038), L3-SMI ( OR=0.959, 95% CI 0.922 to 0.997, P=0.035) and hepatic encephalopathy ( OR=14.724, 95% CI 6.741 to 32.161, P<0.001) were independent influencing factors for OHE in patients with liver cirrhosis. The incidence of OHE in patients with sarcopenia was higher than that of patients without sarcopenia (26.9%, 29/108 vs. 13.2%, 49/372), and the difference was statistically significant ( χ2=10.53, P=0.001). The results of Kaplan-Meier analysis demonstrated that patients with sarcopenia were more likely to develop OHE ( P<0.001). Conclusion:Sarcopenia is closely correlated to OHE and is an independent predictor of OHE in patients with liver cirrhosis.
ABSTRACT
Objective:To analyze the correlation between the body composition and cardiorespiratory fitness (CRF) decline in physical examination population of different genders.Methods:Clinical data of the cardiopulmonary exercise testing (CPET) and body composition analysis of 439 people who received physical examination in the Medical Examination Center of Peking University Third Hospital from May 2021 to September 2021 were retrospectively analyzed. The general data, physical examination, biochemical parameters, body composition and CPET results were collected. The subjects were divided into normal group and decline group according to the percentage of peak oxygen uptake (VO 2peak) levels ≥ 85% or<85%. Multivariate logistic regression was applied to investigate the influencing factors of CRF decline in subjects of different genders. Results:Among men, total cholesterol and triglyceride in the decline group were significantly higher than those in the normal group [(5.097±0.890) vs (4.865±0.856) mmol/L, (1.778±1.200) vs (1.485±0.709) mmol/L], and the blood homocysteine (Hcy) and skeletal muscle index were significantly lower than those in the normal group [13.00 (11.30, 15.90) vs 13.80 (12.05, 17.10) μmol/L, (7.89±0.65) vs (8.08±0.64) kg/m 2] (all P<0.05). Among women, skeletal muscle index in the decline group was significantly lower than that in the normal group [(6.21±0.52) vs (6.53±0.56)kg/m 2], and percent body fat was significantly higher than that in the normal group [(32.83±4.92)% vs (31.21±4.55)%] (all P<0.05). The elevation of triglyceride level ( OR=1.487, 95% CI: 1.042-2.121) and visceral fat area ( OR=1.032, 95% CI: 1.014-1.051) were positively correlated with the decline of CRF in man, the decrease of skeletal muscle index ( OR=0.215, 95% CI: 0.106-0.435) and the increase of percent body fat ( OR=1.149, 95% CI: 1.060-1.245) were positively correlated with the decrease of CRF in women (all P<0.05). Conclusions:There is a correlation between body composition and CRF decline in physical examination population of different genders. Men should control visceral fat more effectively, and women should pay attention to increase muscle mass while reducing body fat, in order to improve CRF.
ABSTRACT
Objective:To explore the risk factors of sarcopenia in liver cirrhosis and construct a diagnosis model for sarcopenia in cirrhosis.Methods:73 patients with liver cirrhosis hospitalized in Department of Gastroenterology of Shanxi Provincial People's Hospital between June 2021 and June 2022 were included. Common measurements in liver cirrhosis and abdominal CT scans of all patients were collected. The cross-sectional area of skeletal muscle at L3 level was calculated by sliceomatic and the skeletal muscle index (SMI) was subsequently obtained by height standardization. The patients were divided into sarcopenia group and non-sarcopenia group using Asian cut-off per European Working Group on Sarcopenia in Older People-2nd meeting (EWGSOP2) criteria. Risk factors related to sarcopenia in cirrhosis were analyzed and a subsequent diagnosis model was established.Results:among the cirrhotic patients included in the study, the prevalence of sarcopenia was 65.75% (48/73), 47.73% (21/44) in males and 93.10% (27/29) in females, respectively. There were significant differences in age, sex, BMI, liver function grade per Child Pugh classification, etiology, ferritin level, prothrombin time and hemoglobin level between sarcopenia and non-sarcopenia groups (P < 0.05). Age, liver function, sex and ferritin level were closely related to the occurrence of sarcopenia in cirrhosis. A diagnostic model was developed based on these 4 indexes and the area under curve reached up to 95.7%.Conclusion:≥ 60 years old, female, Child-Pugh C grade and ferritin < 29.60 μg/L are independent risk factors for sarcopenia in cirrhosis and the model with these indexes shows good diagnostic value for sarcopenia in cirrhosis.
ABSTRACT
OBJECTIVE: To investigate the effect of decreased Skeletal Muscle Index (SMI) and hand grip strength on functional recovery in subacute ambulatory stroke patients. METHODS: Subacute stroke patients who were referred to the rehabilitation center were recruited. Decreased SMI and hand grip strength were diagnosed according to the Asian Working Group on Sarcopenia. Diagnostic criteria were decreased SMI and decreased unaffected hand grip strength. SMI was measured by bioelectrical impedance analysis. Unaffected hand grip strength was measured with a hand dynamometer. Patients were divided into two groups, decreased group (DG) and not-decreased group (NDG), according to the presence of decreased SMI and hand grip strength. Both groups received conventional stroke rehabilitation for 3 weeks. All patients were evaluated at the baseline and at 3 weeks after treatment. Functional status was evaluated with 4-meter walk test (4MWT), 6-minute walk test (6MWT), Timed Up and Go test (TUG), and Modified Barthel Index (MBI). RESULTS: Both groups showed improvement in 4MWT, TUG, and MBI. NDG showed improvement in 6MWT. Comparing improvements between the two groups, NDG showed more improvement in 6MWT and TUG than DG. CONCLUSION: The presence of decreased SMI and hand grip strength had negative effects on functional recovery in subacute ambulatory stroke patients.
Subject(s)
Humans , Asian People , Electric Impedance , Hand Strength , Hand , Muscle, Skeletal , Rehabilitation , Rehabilitation Centers , Sarcopenia , StrokeABSTRACT
L3 skeletal muscle index (L3 SMI) is an emerging nutritional assessment tool. It has been well documented that L3 SMI can correctly reflect body skeletal muscle mass, and can be used to evaluate the prognosis of sarcopenia, chronic liver disease and many malignant tumors. Moreover, it can also be used to predict some surgical complications. This review sums up the recent advances of L3 SMI in evaluating prognosis of diseases.
ABSTRACT
Abstract: Background. Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim. To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material and methods. Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively. Results. Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027). Conclusions. This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/mortality , Sarcopenia/mortality , Liver Cirrhosis/mortality , Liver Neoplasms/mortality , Prognosis , Rome/epidemiology , Time Factors , Tomography, X-Ray Computed , Prevalence , Multivariate Analysis , Retrospective Studies , Risk Factors , Carcinoma, Hepatocellular/secondary , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/diagnostic imaging , Risk Assessment , Kaplan-Meier Estimate , Sarcopenia/diagnostic imaging , Tertiary Care Centers , Liver Cirrhosis/diagnostic imaging , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Liver Neoplasms/diagnostic imagingABSTRACT
To compare the ability of methods based on skeletal muscle index (SMI) and another one by the European Working Group on Sarcopenia in Older People (EWGSOP) based on both muscle mass and physical function in identifying older adults with sarcopenia. Anthropometric measurements and physical performance (hand grip strength and gait speed) were performed. In order to determine the value of SMI, body impedance analysis was also carried out. A total of 426 older adults, mostly women (60.8%) with mean age of 68.4 ± 6.2 years participated in this study. Methods based on SMI and EWGSOP identified 50.5% and 32.2% older adults as sarcopenic respectively. Method based on SMI showed a significantly higher percentage of men (70.7%) were sarcopenic as compared to women (37.5%) (p < 0.05). No such difference was noted for EWGSOP method, with 28.7% of men were sarcopenic as compared to women (34.4%). Binary logistic regression indicated that aged 75 years and above (adjusted odds ratio: 3.3, 95% confidence interval: 1.9 – 5.6) and having arthritis (adjusted odds ratio: 2.5, confidence interval: 1.3 – 4.7) to be associated with sarcopenia as assessed using method recommended by EWGSOP. The lower prevalence of sarcopenia by EWGSOP as compared to SMI may be due to the more comprehensive method by EWGSOP. Further research regarding validation of these two screening methods against a gold standard of screening for sarcopenia is needed in order to identify the best method..
ABSTRACT
BACKGROUND: We performed a retrospective longitudinal study on the effects of changes in weight, body composition, and homeostasis model assessment (HOMA) indices on glycemic progression in subjects without diabetes during a four-year follow-up period in a community cohort without intentional intervention. METHODS: From 28,440 non-diabetic subjects who participated in a medical check-up program in 2004, data on anthropometric and metabolic parameters were obtained after four years in 2008. Body composition analyses were performed with a bioelectrical impedance analyzer. Skeletal muscle index (SMI, %) was calculated with lean mass/weightx100. Subjects were divided into three groups according to weight change status in four years: weight loss ( or =5.0%). Progressors were defined as the subjects who progressed to impaired fasting glucose or diabetes. RESULTS: Progressors showed worse baseline metabolic profiles compared with non-progressors. In logistic regression analyses, the increase in changes of HOMA-insulin resistance (HOMA-IR) in four years presented higher odds ratios for glycemic progression compared with other changes during that period. Among the components of body composition, a change in waist-hip ratio was the strongest predictor, and SMI change in four years was a significant negative predictor for glycemic progression. Changes in HOMA beta-cell function in four years was a negative predictor for glycemic progression. CONCLUSION: Increased interval changes in HOMA-IR, weight gain and waist-hip ratio was associated with glycemic progression during a four-year period without intentional intervention in non-diabetic Korean subjects.