Diagnosis and Pathogenesis of Sarcopenia in Chronic Liver Disease Using Liver Magnetic Resonance Imaging

Abstract

Background Liver magnetic resonance imaging (MRI) is rarely used to evaluate sarcopenia. This study sought to develop new diagnostic criteria for MRI in Asians and investigate the relationship between adipopenia and sarcopenia using MRI proton density fat fraction (PDFF), which is correlated with body fat mass. Methodology This study included 512 patients with chronic liver disease (CLD) who underwent magnetic resonance elastography (MRE). The following parameters were assessed: paraspinal muscle area/height index (PSMI) measured at the level of the superior mesenteric artery and PDFF. The cutoff PSMI and PDFF values for the diagnosis of sarcopenia and adipopenia, respectively, were determined using receiver operating characteristic analysis of Asians with low body mass index. Results Among patients with CLD, the prevalence rates of sarcopenia and adipopenia were 25% and 17%, respectively. We found that sarcopenia increased from stage 3 fibrosis and was inversely correlated with steatosis grade. Multivariate analysis found that MRI-PDFF was associated with sarcopenia. The Kaplan-Meier method in cirrhosis (n = 122) showed that the non-sarcopenia, sarcopenia, and sarcopenia/adipopenia groups had three-year survival rates of 97%, 55% (p < 0.01), and 23%, respectively. The Cox proportional hazards model identified the Child-Pugh score and sarcopenia/adipopenia as independent prognostic factors. Conclusions The new diagnostic criteria for sarcopenia confirmed that the prognosis of cirrhosis can be stratified. Furthermore, sarcopenia with adipopenia was shown to be a phenotype of severe sarcopenia in cirrhosis, and screening for sarcopenia should include cases in the precirrhotic stage.

Prevalence of Sarcopenia in Liver Cirrhosis: A Systematic Review and Meta-Analysis

“…Two sarcopenia entries Resulted from muscle deficits estimated by the psoas muscle index of L3 ( 32 , 35 ). Finally, a single prevalence entry was derived from the construct used by ( 37 ), namely, a paraspinal muscle index deficiency, diagnosed on values <12.62 cm 2 /m 2 for men and <9.77 cm 2 /m 2 for women.…”

“…As an assessment tool for body composition, most studies used CT scans to quantify muscle mass (Table 2 ). Only 6 sarcopenia entries were derived from BIA ( 22 , 24 , 26 , 27 , 29 , 30 , 54 ) and just 1 from DXA ( 33 ) and 2 for MRI ( 21 , 37 ). For handgrip strength estimation, dynamometry was chosen in 12 studies to estimate the prevalence of sarcopenia, combined with appendicular muscle mass.…”

Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease

“…Sarcopenia prevalence in patients with liver cirrhosis (LC) of different aetiologies (prevalence of cirrhotic NASH not specified) varies between 21.7% and 76% [ 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. In studies involving patients with LC of different aetiologies and with a prevalence of NASH/NAFLD ranging from 9.8% to 34.5%, sarcopenia prevalence varies from 19.8% to 48% [ 79 , 80 , 81 ]. In a meta-analysis of 22 studies involving 6965 patients [ 82 ], the pooled prevalence of sarcopenia in patients with LC was 37.5% overall (95% CI 32.4–42.8%) and was higher in males, those with alcohol-associated liver disease, those with Child–Pugh grade C and when sarcopenia was defined by L3-SMI (i.e., assessed with the third lumbar skeletal muscle index) [ 82 , 83 ], independently of the model for end-stage liver disease score (MELD) [ 83 ].…”

“…In patients with LC, sarcopenia has been associated with reduced quality of life [ 85 , 86 ]; increased risk of LC complications, such as ascites [ 76 , 87 , 88 , 89 , 90 ], hepatic encephalopathy (HE) [ 20 , 87 , 88 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ], HCC [ 76 , 100 , 101 , 102 ], variceal bleeding [ 88 ], spontaneous peritonitis [ 76 ], infections [ 76 ], more extended hospital stays [ 76 , 103 , 104 ], higher hospital costs [ 103 , 104 ], higher 30-day readmission [ 76 ] and overall increased mortality [ 78 , 82 , 89 , 92 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 ]; as well as reduced survival [ 76 , 81 , 113 , 114 , 115 , …”

Sarcopenia and malnutrition in patients with liver diseases

“…Сведения по распространенности саркопении, представленные в литературе, вариабельны. По данным разных исследователей, распространенность саркопении при хронических заболеваниях печени составляет от 30-33 до 54-57% [6][7][8]. Распространенность саркопении увеличивается по мере прогрессирования заболевания.…”