Muscle atrophy as pre-sarcopenia in Japanese patients with chronic liver disease: computed tomography is useful for evaluation

Abstract

Background/AimThe definition of muscle atrophy (pre-sarcopenia) and its diagnostic criteria have not been well reported. To elucidate the frequency of pre-sarcopenia in chronic liver disease (CLD), we examined clinical features of Japanese CLD patients using abdominal computed tomography (CT) findings.MethodsWe enrolled 988 CLD (736 with naïve hepatocellular carcinoma) and 372 normal control subjects (NCs). The psoas muscle area index [PI, psoas muscle area at the mid-L3 level in CT (cm2)/height (m)2] was calculated using personal computer software. The cut-off level for pre-sarcopenia was defined as less than two standard deviations (SDs) below the mean PI value in the NCs under 55 years old [males, 45.6 ± 5.7 years (n = 61), 4.24 cm2/m2; females, 47.0 ± 6.1 years (n = 49), 2.50 cm2/m2]. Elderly was defined as 65 years or older. Clinical features were retrospectively evaluated.ResultsIn the CLD group (HCV:HBV:HBV and HCV:alcohol:non-HBV and HCV = 652:88:7:82:159), pre-sarcopenia was observed in 15.3 % of patients with chronic hepatitis (CH), 24.4 % of those with liver cirrhosis (LC) Child-Pugh A, 37.7 % of those with LC Child-Pugh B, and 37.1 % of those with LC Child-Pugh C. A comparison between NC and CH by age (<55, 55–64, 65–74, ≥75 years) showed that the frequency of pre-sarcopenia was higher in CH regardless of age (1.8 vs. 3.6 %, 3.2 vs. 15.9 %, 4.9 vs. 13.4 %, 14.3 vs. 20.2 %, respectively). PI values showed correlations with BMI (r = 0.361), age (r = −0.167), albumin (r = 0.115), and branched-chain amino acids (r = 0.199) (P < 0.01).ConclusionRetrospective evaluate for pre-sarcopenia was easy to perform with CT findings. Nutrition and exercise instruction should be considered for early stage and even non-elderly CLD as well as LC.

Impact of muscle volume and muscle function decline in patients undergoing surgical resection for hepatocellular carcinoma

“…European Working Group on Sarcopenia in Older People, AWGS, and JSH have defined sarcopenia as MVL coexisting with muscle strength decline. In patients with CLD, sarcopenia, MVL, and muscle strength decline are not rare, even in an early stage . In addition, MVL has recently been reported as a prognostic factor for survival in HCC patients treated with liver transplantation, surgical resection, or sorafenib, although few reports have elucidated the relationship between muscle function and prognosis of HCC patients following surgical resection.…”

Validity of Japanese version of SARC‐F questionnaire in patients with chronic liver disease

“…reported a 44% prevalence of sarcopenia in patients with chronic liver disease, including those with hepatocellular cancer and liver cirrhosis, when sarcopenia was defined based on the Psoas muscle index using the area of the Psoas muscle at the L3 level on CT. Furthermore, Hiraoka et al . reported that the prevalence of sarcopenia increased with a more advanced Child–Pugh classification in chronic liver disease patients, mainly with liver cirrhosis, when sarcopenia was defined by the psoas muscle index at the L3 level on CT.…”

Significance of psoas muscle thickness as an indicator of muscle atrophy in patients with hepatocellular carcinoma treated with sorafenib

“…Dual energy X-ray absorptiometry (DXA) (17), BIA (18) and CT (19,20) have been widely used to measure skeletal muscle mass. However, since DXA and BIA are sensitive to water composition, they are not considered suitable for patients with cirrhosis.…”