The evaluation of sarcopenia in chronic liver disease

End stage liver disease (ESLD) has a significant impact on the homeostasis of muscle, with observed reductions in muscle mass, performance and function due to an ongoing catabolic state. This study carried out a multi-modal assessment, including MRI, muscle functional measures and analysis of serum and muscle biopsies, to evaluate and phenotype sarcopenia and frailty in those with ESLD and to determine the mechanisms driving compromised muscle health. The study recruited 53 patients with ESLD, 39 of whom completed the multi-modal assessments, and 18 age and sex matched healthy controls. The ESLD cohort had a median age of 57.5 (IQR 50.0-61.3) years with 61.9% male predominance and the controls had a median age of 51.5 (IQR 33.0-63.3) years with 61.1% who were male . The disease aetiologies were 47.9% alcohol related disease, 14.3% NAFLD and 33.3% autoimmune disease. The findings highlighted that reduced muscle mass, quality and function (as measured by strength and performance) were reduced in those with ESLD compared to healthy controls, that when evaluating changes in muscle composition, muscle mass, quality and function should all be considered in those with ESLD. This study found that quadriceps measures of muscle mass from MRI and ultrasound, correlated to the commonly used standard of L3 SMI, supporting its future use as a functionally relevant muscle group. Further, the results showed that muscle mass, quality and function were impacted by ascites, hepatic encephalopathy, aetiology of ESLD, age and sex, supporting the consideration of these variables when evaluating muscle health in ESLD. Finally, the muscle phenotype in patients with ESLD was broken down in to those with adequate muscle mass and function, those with adequate mass but inadequate function and those with inadequate mass and function. Comparing these distinct phenotypes revealed clear differences in the mechanisms potentially driving muscle wasting in ESLD at a molecular and transcriptomic level; notably altered adrenal steroids, mitochondrial dysfunction, cellular senescence, altered regulation of protein synthesis and pro-inflammatory pathways were identified as differential influences on muscle phenotype. Taken together, these data support the need for a multi-modal assessment to evaluate sarcopenia and frailty in ESLD with targets for future research highlighted

The Impact of Slice Interval and Equation on the Accuracy of Magnetic Resonance Image Estimation of Quadriceps Muscle Volume in End Stage Liver Disease

INTRODUCTION: End stage liver disease (ESLD) is associated with loss of muscle mass and function, known as sarcopenia, which can increase the risk of complications of ESLD, hospitalization and mortality. Therefore, the accurate assessment of muscle mass is essential to evaluate sarcopenia in ESLD. However, manual segmentation of muscle volume (MV) can be laborious on cross-sectional imaging, due to the number of slices that require analysis. This study aimed to investigate the impact of reducing the number of slices required for MV estimation. Further, we aimed to compare two equations utilized in estimating MV (cylindrical and truncated cone). METHODS: Thirty eight ESLD patients (23 males; 54.8 ± 10.7 years) were recruited from the Queen Elizabeth University Hospital Birmingham. A 3T MRI scan was completed of the lower limbs. Quadriceps MV was estimated utilizing 1-, 2-, 3-, and 4 cm slice intervals with both cylindrical and truncated cone equations. Absolute and relative error (compared to 1 cm slice interval) was generated for 2-, 3-, and 4 cm slice intervals. L3 skeletal muscle index (SMI) was also calculated in 30 patients. RESULTS: Relative error increased with slice interval using the cylindrical (0.45 vs. 1.06 vs. 1.72%) and truncated cone equation (0.27 vs. 0.58 vs. 0.74%) for 2, 3, and 4 cm, respectively. Significantly, the cylindrical equation produced approximately twice the error compared to truncated cone, with 3 cm (0.58 vs. 1.06%, P < 0.01) and 4 cm intervals (0.74 vs. 1.72%, P < 0.001). Finally, quadriceps MV was significantly correlated to L3 SMI (r(2) = 0.44, P < 0.0001). CONCLUSION: The use of the truncated equation with a 4 cm slice interval on MRI offers an efficient but accurate estimation of quadricep muscle volume in ESLD patients

The Impact of Slice Interval and Equation on the Accuracy of Magnetic Resonance Image Estimation of Quadriceps Muscle Volume in End Stage Liver Disease

IntroductionEnd stage liver disease (ESLD) is associated with loss of muscle mass and function, known as sarcopenia, which can increase the risk of complications of ESLD, hospitalization and mortality. Therefore, the accurate assessment of muscle mass is essential to evaluate sarcopenia in ESLD. However, manual segmentation of muscle volume (MV) can be laborious on cross-sectional imaging, due to the number of slices that require analysis. This study aimed to investigate the impact of reducing the number of slices required for MV estimation. Further, we aimed to compare two equations utilized in estimating MV (cylindrical and truncated cone).MethodsThirty eight ESLD patients (23 males; 54.8 ± 10.7 years) were recruited from the Queen Elizabeth University Hospital Birmingham. A 3T MRI scan was completed of the lower limbs. Quadriceps MV was estimated utilizing 1-, 2-, 3-, and 4 cm slice intervals with both cylindrical and truncated cone equations. Absolute and relative error (compared to 1 cm slice interval) was generated for 2-, 3-, and 4 cm slice intervals. L3 skeletal muscle index (SMI) was also calculated in 30 patients.ResultsRelative error increased with slice interval using the cylindrical (0.45 vs. 1.06 vs. 1.72%) and truncated cone equation (0.27 vs. 0.58 vs. 0.74%) for 2, 3, and 4 cm, respectively. Significantly, the cylindrical equation produced approximately twice the error compared to truncated cone, with 3 cm (0.58 vs. 1.06%, P &lt; 0.01) and 4 cm intervals (0.74 vs. 1.72%, P &lt; 0.001). Finally, quadriceps MV was significantly correlated to L3 SMI (r2 = 0.44, P &lt; 0.0001).ConclusionThe use of the truncated equation with a 4 cm slice interval on MRI offers an efficient but accurate estimation of quadricep muscle volume in ESLD patients

Sarcopenia in cirrhosis: A practical overview.

Patients with liver cirrhosis and, in particular, those with liver failure are at high risk of reduced muscle mass and strength/function, otherwise known as sarcopenia. Sarcopenia is a complex, multifactorial (poor nutritional intake, protein catabolism, physical inactivity) chronic condition, which increases the risk of liver-related morbidity and mortality. Early recognition and tailored management incorporating high protein diets and combination aerobic/resistance exercise can ameliorate the complications associated with sarcopenia in cirrhosis. This review provides an overview of the epidemiology, pathogenesis, assessment tools and management of sarcopenia in cirrhosis

Sarcopenia in Non-alcoholic Fatty Liver Disease: New challenges for clinical practice.

: Sarcopenia is increasingly recognised in patients with non-alcoholic liver disease (NAFLD). Initially recognised as a consequence of advanced liver disease, there is now emerging evidence that sarcopenia may be a novel risk factor for the development of NAFLD, with a role in fibrosis and disease progression.: This review examines the epidemiology, pathogenesis and complex interplay between NAFLD and sarcopenia. Furthermore, the authors discuss the challenges with diagnosis of sarcopenia in the clinic and the evidence-based management of sarcopenia in patients with NAFLD. A MEDLINE and PubMed search was undertaken using the terms; "sarcopenia", "frailty", "muscle", "obesity", "non-alcoholic fatty liver disease", "non-alcoholic steatohepatitis" and "cirrhosis" up to 31 September 2019.: Sarcopenia may be masked by the co-existence of morbid obesity, which is most notable in patients with NAFLD. Sarcopenia is a key indicator of adverse outcomes in patients with cirrhosis, such as hepatic decompensation, poor quality of life and premature mortality. Patients with NAFLD and advanced fibrosis/cirrhosis should undergo anthropometric measures (hand grip strength), dry body mass index and measures of physical frailty (including muscle function, not just mass) to enable targeted early interventions of nutrition (low fat, 1.5g/kg/day protein intake, 2-3 hourly food intake) and exercise (combined resistance and aerobic)

Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview.

Malnutrition is a common condition encountered in patients with inflammatory bowel disease (IBD) and is often associated with sarcopenia (the reduction of muscle mass and strength) which is an ever-growing consideration in chronic diseases. Recent data suggest the prevalence of sarcopenia is 52% and 37% in Crohn's disease and ulcerative colitis, respectively, however it is challenging to fully appreciate the prevalence of sarcopenia in IBD. Sarcopenia is an important consideration in the management of IBD, including the impact on quality of life, prognostication, and treatment such as surgical interventions, biologics and immunomodulators. There is evolving research in many chronic inflammatory states, such as chronic liver disease and rheumatoid arthritis, whereby interventions have begun to be developed to counteract sarcopenia. The purpose of this review is to evaluate the current literature regarding the impact of sarcopenia in the management of IBD, from mechanistic drivers through to assessment and management