Serum Zinc Level Is Associated with Frailty in Chronic Liver Diseases

Nishikawa, Hiroki; Enomoto, Hirayuki; Iwata, Yoshinori; Sakai, Yoshiyuki; Kishino, Kyohei; Shimono, Yoshihiro; Ikeda, Naoto; Takashima, Tomoyuki; Aizawa, Nobuhiro; Takata, Ryo; Hasegawa, Kunihiro; Koriyama, Takashi; Yuri, Yukihisa; Nishimura, Takashi; Nishiguchi, Shuhei; Iijima, Hiroko

doi:10.3390/jcm9051570

Cited by 9 publications

(7 citation statements)

References 46 publications

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“…The cutoff values of CC for sarcopenia in the revised AWGS guidelines are 34 cm in males and 33 cm in females, while in our ROC analysis for frailty, the optimal cutoff values of CC were 33.7 cm in males and 33.4 cm in females, which are almost identical to AWGS data [19,34]. Sarcopenia indicates physical frailty and sarcopenia forms the basis of frailty [2,35]. Sarcopenia itself causes lower limb muscle strength, falls, slow WS, and thus, decrease in physical activity can be induced.…”

Section: Discussionsupporting

confidence: 76%

Anthropometric Measurements and Frailty in Patients with Liver Diseases

et al. 2020

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There have been scarce data regarding the relationship between frailty and anthropometry measurements (AMs) in patients with chronic liver diseases (CLDs). We aimed to elucidate the influence of AMs on frailty in CLDs (median age = 66 years, 183 men and 192 women). AMs included arm circumference, triceps skinfold thickness, calf circumference (CC), waist circumference, and body mass index. Frailty assessment was done by using five phenotypes (body weight loss, exhaustion, decreased muscle strength, slow walking speed, and low physical activity). Robust (frailty point 0), prefrail (frailty point 1 or 2), and frailty (frailty point 3 or more) were observed in 63 (34.4%), 98 (53.6%), and 22 (12.0%) of males, respectively, and 63 (32.8%), 101 (52.6%), and 28 (14.6%) of females, respectively. In receiver operating characteristics (ROC) curve analyses for the presence of frailty, CC had the highest area under the ROC (AUC) both in male (AUC = 0.693, cutoff point = 33.7 cm) and female (AUC = 0.734, cutoff point = 33.4 cm) participants. In the multivariate analysis associated with frailty, for the male participants, only the presence of liver cirrhosis (p = 0.0433) was identified to be significant, while among the female participants, serum albumin (p = 0.0444) and CC (p = 0.0010) were identified to be significant. In conclusion, CC can be helpful for predicting frailty, especially in female CLD patients.

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Section: Discussionsupporting

confidence: 76%

Anthropometric Measurements and Frailty in Patients with Liver Diseases

et al. 2020

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“…Deficiency of zinc, a cofactor in the urea cycle that metabolizes ammonium, is associated with HE, frailty, and sarcopenia in patients with cirrhosis. (19)(20)(21) Magnesium deficiency occurs because of malabsorption of magnesium in the small intestine and is exacerbated by diuretic use. Magnesium deficiency is associated with reduced cognitive performance as well as reduced muscle strength in adults with cirrhosis (22)(23)(24) and with increased bone resorption in children with cholestatic liver disease.…”

Section: Impaired Intake Of Micronutrientsmentioning

confidence: 99%

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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This is the first American Association for the Study of Liver Diseases (AASLD) Practice Guidance on the management of malnutrition, frailty, and sarcopenia in patients with cirrhosis. This guidance represents the consensus of a panel of experts after a thorough review and vigorous debate of the literature published to date, incorporating clinical experience and common sense to fill in the gaps when appropriate. Our goal was to offer clinicians pragmatic recommendations that could be implemented immediately in clinical practice to target malnutrition, frailty, and sarcopenia in this population. This AASLD Guidance document differs from AASLD Guidelines, which are supported by systematic reviews of the literature, formal rating of the quality of the evidence and strength of the recommendations, and, if appropriate, meta-analysis of results using the Grading of Recommendations Assessment Development and Evaluation system. In contrast, this Guidance was developed by consensus of an expert panel and provides guidance statements based on formal review and analysis of the literature on the topics, with oversight Accepted ArticleThis article is protected by copyright. All rights reserved provided by the AASLD Practice Guidelines Committee at all stages of Guidance development. The AASLD Practice Guidelines Committee chose to perform a Guidance on this topic because a sufficient number of randomized controlled trials (RCTs) were not available to support the development of a Guideline. Definitions of Malnutrition, Frailty, and Sarcopenia and Their Relationship in Patients With CirrhosisCirrhosis is a major predisposing condition for the development of malnutrition, frailty, and sarcopenia.Multiple, yet complementary, definitions of these conditions exist in the published domain outside of the field of hepatology, but consensus definitions have not yet been established by the AASLD for patients with cirrhosis. Furthermore, there has been ambiguity related to operationalization of these constructs in clinical practice. To address this, we offer definitions of the theoretical constructs of malnutrition, frailty, and sarcopenia as commonly represented in all populations, partnered with operational definitions, developed by consensus, to facilitate pragmatic implementation of these constructs in clinical practice as applied to patients with cirrhosis (Table 1). Malnutrition is a clinical syndrome that results from "an imbalance (deficiency or excess) of nutrients that causes measurable adverse effects on tissue/body form (body shape, size, composition) or function, and/or clinical outcome." 1 Key to this definition is the recognition that malnutrition represents a spectrum of nutritional disorders across the entire range of body mass index (BMI)from underweight to obese. By this definition, malnutrition leads to adverse physical effects, which, in patients with cirrhosis, are commonly manifested phenotypically as frailty or sarcopenia. Frailty has most commonly been defined as a clinical state of decreased physiologic reserve...

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“…Some aspects regarding pathophysiological pertubations have also been depicted in patients with cirrhosis and frailty. Nishikawa and colleagues reported that the circulating levels of zinc correspond well to the aggravating frail status ranging from robustness to frailty in patients with cirrhosis, concerning zinc deficiency in close relation to various clinical symptoms like malnutrition, musculoskeletal health decline and hormonal imbalance 81 . A spectrum of hormonal changes, including decreased parathyroid hormone, testosterone, cortisol and vitamin D3, was found in patients with cirrhosis and frailty, addressing the pathway of dysregulated hormone homeostasis and consequently endocrine/metabolic dysfunction 82 .…”

Section: The Interrelation Between Frailty and Other Cirrhosis‐associ...mentioning

confidence: 99%

“…Nishikawa and colleagues reported that the circulating levels of zinc correspond well to the aggravating frail status ranging from robustness to frailty in patients with cirrhosis, concerning zinc deficiency in close relation to various clinical symptoms like malnutrition, musculoskeletal health decline and hormonal imbalance. 81 A spectrum of hormonal changes, including decreased parathyroid hormone, testosterone, cortisol and vitamin D3, was found in patients with cirrhosis and frailty, addressing the pathway of dysregulated hormone homeostasis and consequently endocrine/metabolic dysfunction. 82 Furthermore, low serum free triiodothyronine levels were associated with the presence of frailty in euthyroid patients with cirrhosis, which was independent of sodium, age and CTP classification.…”

Section: Miscellaneousmentioning

confidence: 99%

Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

Deng

Hui

Cui

et al. 2023

Liver International

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Given the multifactorial nature and complex pathogenesis in relation to liver cirrhosis, it is justified to stratify progression risk and to prognosticate mortality in terms of various pathological pertubations alongside laboratory markers. In other words, conventional scoring systems, such as the model for end-stage liver disease (MELD) or Child-Turcotte-Pugh (CTP) classification, may fail to capture specific derangements across multiple physiological pillars, which include but not limited to musculoskeletal, endocrine, neurological,

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Serum Zinc Level Is Associated with Frailty in Chronic Liver Diseases

Cited by 9 publications

References 46 publications

Anthropometric Measurements and Frailty in Patients with Liver Diseases

Anthropometric Measurements and Frailty in Patients with Liver Diseases

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

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