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
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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)