Background: Patients with inflammatory bowel disease (IBD) often have low weight, malnutrition and sarcopenia. The criteria of sarcopenia used were European and American standards previously. The aim of the study was to evaluate the impact of sarcopenia on clinical outcomes in patients with IBD using the Asian Working Group for Sarcopenia 2019 (AWGS2019) criteria. Methods:The inclusion of the subjects was IBD patients between 18 to 60 years. Sarcopenia, presarcopenia and sarcopenic obesity were defined. Participants were followed up for 90 days. Information as to whether the symptoms improved, treatment plans changed, underwent surgery, were readmitted to the hospital, or died was recorded. Analyses of chi-square test, t-test, cumulative survival analysis and receiver operating characteristic (ROC) curves were done through SPSS25.0 software. Odds ratio (OR) and 95% confidence interval (CI) were calculated.Results: A total of 110 patients with IBD were included. The prevalence of pre-sarcopenia was 44.6% and of sarcopenia 50.8%. Body mass index (BMI) (P=0.018; OR =0.449) and albumin (Alb) levels were lower (P=0.004; OR =0.608) in the sarcopenia group than the control and pre-sarcopenia groups, and they were risk factors for sarcopenia. Meanwhile, a history of more frequent alcohol consumption, parenteral manifestations, IBD-related complications, higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significant statistic different for sarcopenia group compared with others. Rates of surgery (P<0.001; OR =6.651), re-hospitalization (P<0.001; OR =6.344) or death (P=0.003) were higher in the sarcopenia group than in the control group. The sarcopenia group had higher rates of surgery (P=0.022; OR =3.608) and re-hospitalization (P=0.048; OR =5.500) than the pre-sarcopenia group after adjustment analysis.Patients in the sarcopenic obesity group with body fat percentages ≥24.8% (P=0.039; 95% CI: 0.590-1.000) in men and ≥32.0% (P=0.006; 95% CI: 0.692-1.000) in women were more likely to receive surgery, female patients with that ≥24.5% (P=0.025; 95% CI: 0.556-1.000) were more likely to experience re-hospitalization.Conclusions: Patients with IBD diagnosed with sarcopenia or sarcopenic obesity based on AWGS2019 criteria had poorer outcomes. The AWGS2019 criteria are comprehensive and more suitable for predicting outcomes in IBD patients, which helps doctors making precise treatment.
Sarcopenia is a clinical condition characterized by a reduction in muscle mass, which typically affects adult patients; however, it has recently been recognized in pediatric literature. Few studies in children with chronic liver disease (CLD) undergoing liver transplantation (LT) have investigated the role of sarcopenia, with controversial results. The aim of our study was to assess the prevalence and impact of sarcopenia among children with CLD who are candidates for LT. We conducted a retrospective, single-center study at Bambino Gesù Children's Hospital (Rome, Italy) from July 2016 to July 2021, evaluating all children (0–16 years old) with CLD listed for LT with an abdomen computed tomography imaging available before LT. The total psoas muscle surface area (t-PMSA) was defined as the sum of left and right psoas muscle surface area measured at L4–L5 on axial images. The t-PMSA z-score was calculated according to reference data, and sarcopenia was defined as a t-PMSA z-score of ≤−2 (1–16 years) or a psoas muscle index [PMI; PMI = t-PMSA/(100 × BSA)] of <50th percentile of the population examined (<1 year). Clinical, laboratory, and LT outcome data were collected from all the patients with CLD. 27 out 48 (56%) of the patients aged 1–16 years were sarcopenic. No differences were noted in anthropometrics, nutritional support, liver function tests, model for ESLD (MELD), or pediatric ESLD (PELD) scores between patients with and without sarcopenia. The former showed a higher prevalence of respiratory complications (66.7% vs. 42.1%) and need for inotropes (40.7% vs. 10.8%) after LT. Among patients aged 0–1 years (n: 36), those with reduced muscle mass (50%) had a longer hospitalization time (44 vs. 24 days) and higher incidences of multi-organ failure syndrome (38.9% vs. 0%) and intensive care unit-related infections (61.1% vs. 27.8%) compared to those with greater muscle mass. t-PMSA and PMI were statistically significant predictors of LT outcomes. Sarcopenia is a reliable index of frailty in children with CLD, as its presence is associated with the risk of a more challenging LT. Future studies will have to investigate the functional aspects of sarcopenia and conceive preventive measures of muscle wasting in CLD patients.
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