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

Journal of Gastroenterology, Mar 2015

Background/Aim The 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. Methods We 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. Results In 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). Conclusion Retrospective 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.

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

Muscle atrophy as pre-sarcopenia in Japanese patients with chronic liver disease: computed tomography is useful for evaluation Atsushi Hiraoka 0 1 Toshihiko Aibiki 0 1 Tomonari Okudaira 0 1 Akiko Toshimori 0 1 Tomoe Kawamura 0 1 Hiromasa Nakahara 0 1 Yoshifumi Suga 0 1 Nobuaki Azemoto 0 1 Hideki Miyata 0 1 Yasunao Miyamoto 0 1 Tomoyuki Ninomiya 0 1 Masashi Hirooka 0 1 Masanori Abe 0 1 Bunzo Matsuura 0 1 Yoichi Hiasa 0 1 Kojiro Michitaka 0 1 0 Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine , Toon, Ehime , Japan 1 Gastroenterology Center, Ehime Prefectural Central Hospital , Kasuga-cho 83, Matsuyama, Ehime 790-0024 , Japan Background/Aim The definition of muscle atrophy (presarcopenia) 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. Methods We enrolled 988 CLD (736 with nave 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 presarcopenia 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. Results In 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, C75 years) showed that the frequency of pre-sarcopenia was higher in CH regardless of age (1.8 vs. 3.6 %, 3.2 vs. Chronic liver disease; Liver cirrhosis; Chronic hepatitis; Muscle atrophy; Sarcopenia - Sarcopenia, initially introduced by Rosenberg [1], has been proposed to be an age-related muscle atrophy (pre-sarcopenia) that appears in combination with low muscle strength and/or physical performance condition in the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) [2]. In general, sarcopenia including muscle atrophy is frequently observed with aging, while it has also been shown to be associated with chronic diseases [e.g., heart failure, obstructive pulmonary disease, diabetes mellitus, kidney disease, connective tissue disease, tuberculosis infection, other wasting conditions] [3]. Presarcopenia is the first step of the condition and a mandatory item for diagnosis of sarcopenia [2]. Although it is thought to have clinical importance for the clinical course of chronic liver disease (CLD) patients [4, 5] and in therapy results for hepatocellular carcinoma (HCC) in liver cirrhosis (LC) [68], the clinical features of pre-sarcopenia in CLD patients [chronic hepatitis (CH), LC] have not been well elucidated. Moreover, a preferred imaging modality for diagnosing pre-sarcopenia and concrete cut-off levels have not been established. Computed tomography (CT) examinations are commonly performed as part of health checkup programs as well as in Japanese patients with CLD for screening of HCC. However, diagnostic criteria based on CT findings have not been established for presarcopenia. In the present study, we determined the psoas muscle area to establish concrete cut-off levels for muscle atrophy in males and females using CT, and also elucidate clinical features of pre-sarcopenia in CLD patients. We enrolled 988 patients with CLD who were treated at Ehime Prefectural Central Hospital from January 2005 to December 2014, as well as 372 normal controls subjects (NCs) who underwent a PET/CT examination as part of a medical check-up procedure in 2013 at the same hospital. Of the 988 CLD patients [age range 2293 years, mean 68.4 4.5 years; male:female = 684:304; hepatitis C virus (HCV):hepatitis B virus (HBV):HBV and HCV:alcohol:non-HBV and HCV (negative for both hepatitis B surface antigen and anti-HCV) = 652:88:7:82:159], 736 had a nave HCC. The psoas muscle area index (PI) [psoas muscle area at the middle of the third lumbar vertebra (L3) (cm2)/height (m)2] was manually calculated from CT findings using personal computer software (Centricity Web DX ver.3.7.3.6417: GE Healthcare) (Fig. 1). Elderly was defined as 65 years old or older. After confirmation that psoas muscle area has a close relationship with total muscle area at the L3 level (r = 0.802, P \ 0.001), it was calculated for all patients and the NC. The cut-off PI value for pre-sarcopenia was defined as less than two standard deviations (SDs) below the mean PI for males and females in the NC group who were under 54 years old. PI val (...truncated)


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Atsushi Hiraoka, Toshihiko Aibiki, Tomonari Okudaira, Akiko Toshimori, Tomoe Kawamura, Hiromasa Nakahara, Yoshifumi Suga, Nobuaki Azemoto, Hideki Miyata, Yasunao Miyamoto, Tomoyuki Ninomiya, Masashi Hirooka, Masanori Abe, Bunzo Matsuura, Yoichi Hiasa, Kojiro Michitaka. Muscle atrophy as pre-sarcopenia in Japanese patients with chronic liver disease: computed tomography is useful for evaluation, Journal of Gastroenterology, 2015, pp. 1206-1213, Volume 50, Issue 12, DOI: 10.1007/s00535-015-1068-x