Introduction: In patients with cirrhosis, highly prevalent vitamin D deficiency and low bone mineral density (BMD) increase the burden of disease, and role of vitamin D supplementation is not clear. So, our aim was to determine the effect of vitamin D supplementation on vitamin D level and BMD in patients with cirrhosis. Methods: Patients with cirrhosis (18–60 years) of any etiology were enrolled. We measured serum 25(OH)D, parathyroid hormone, thyroid-stimulating hormone, free T4, bone-specific alkaline phosphatase, insulin-like growth factor (IGF)-1, and health-related quality of life at entry and at 1 year; however, serum calcium was measured at 3-month interval. BMD was measured by dual-energy x-ray absorptiometry at lumbar spine and left hip neck at entry and after 1 year. Statistical analysis was performed according to intention-to-treat analysis. Results: Of 390 screened patients with cirrhosis, 164 participants (82 in each group) were randomized. There was significant increase in 25(OH)D levels in intervention group after 1 year (33.7 [24.3–45.7] ng/mL vs 23.1 [17–28.2] ng/mL; P < 0.001) when compared with placebo. The mean difference in BMD at lumbar spine and left hip neck was not significantly changed after 1 year of intervention with vitamin D between both groups. There was no significant change in both the groups in levels of calcium, thyroid-stimulating hormone, parathyroid hormone, free T4, IGF-1, and bone-specific alkaline phosphatase and quality of life. Discussion: Supplementation with vitamin D for 1 year improves vitamin D levels but did not result in improvement in BMD at lumbar spine and left hip neck in patients with cirrhosis.
Background & aims: This study was planned to evaluate triceps skinfold thickness (TSFT), mid-arm muscle circumference (MAMC) and bioelectrical impedance analysis (BIA) for assessing body composition using dual-energy X-ray absorptiometry (DEXA) (reference) and to predict fat mass (FM) and fat-free mass (FFM) in patients with cirrhosis. Methods: FM and FFM were assessed by using DEXA and BIA. Skin-fold calliper was used for measuring TSFT, and MAMC was calculated. Bland-Altman plot was used to determine agreement and linear regression analysis for obtaining equations to predict FM and FFM. Results: Patients with cirrhosis (n = 302, 241 male, age 43.7 ± 12.0 years) were included. Bland-Altman plot showed very good agreement between BIA and DEXA for the estimation of FM and FFM. Majority of patients were within the limit of agreement: FM (98%) and FFM (96.4%). BIA shows a positive correlation with DEXA:FM (r = 0.73, p # 0.001) and FFM (r = 0.86, p # 0.001). DEXA (FM and FFM) shows a positive correlation with TSFT (r = 0.69, p # 0.01) and MAMC (r = 0.61, p # 0.01). The mean difference between the observed and predicted value of FM and FFM by BIA in the developmental set was 0.01 and 0.05, respectively; whereas in the validation set, it was À0.13 and 0.86, respectively. The mean difference between the observed and predicted value of TSFT and MAMC in the developmental set was 0.43 and 0.07; whereas, in the validation set, it was 0.16 and 0.48, respectively. Conclusion: Anthropometry (TSFT and MAMC) and BIA are simple and easy to use and can be a substitute of DEXA for FM and FFM assessment in routine clinical settings in patients with cirrhosis. ( J CLIN EXP HEPATOL xxxx;xxx:xxx) M alnutrition is common and has been shown to adversely affect the clinical outcome in cirrhosis. 1,2 Its prevalence varies from 60 to 90% and increases as the stage of liver disease advances. [3][4][5] Malnutrition leads to increased risk of complications, infections, recurrent hospitalizations, poor quality of life, and decreased survival. [6][7][8][9] Despite its relevance, malnutrition is frequently underdiagnosed in patients with cirrhosis. 10 Diagnosing malnutrition in liver cirrhosis is equally challenging due to ascites and edema. Hence, nutritional assessment is vital for the early diagnosis of malnutrition, for early intervention to prevent further complications, and to monitor impact of management in patients with cirrhosis.Body composition analysis is commonly used for nutritional assessment in the early stage and monitoring various diseases, and there are several tools available for its assessment. 11 Body mass index (BMI) is not a good tool for nutritional assessment due to its fallacy in liver disease. Dual-energy X-ray absorptiometry (DEXA) is the reference standard for nutritional assessment because its ability to estimate bone mineral content (BMC), fat mass (FM), and lean body mass (LBM) accurately and quickly. 11 However, due to its unavailability, high cost, and use of ionizing radiation, DEXA is used mainly in research se...
Background The impact of longitudinal changes in different body components measured via body composition analysis(BCA) on liver related outcomes in patients with cirrhosis is poorly understood. We evaluated the prognostic relevance these changes in body composition over 1 year in patients with cirrhosis with regard to their long-term outcomes. Methods This was a follow-up study of a randomised controlled trial evaluating changes in bone density measured via dual energy X-ray absorptiometry(DEXA) upon vitamin-D supplementation. Patients with available anthropometric indices, fat mass(FM), fat-free mass(FFM), bone-density at lumbar spine(LD) and left femur-neck(FD)(assessed by T-score) at two time points 1 year apart were assessed for outcomes. The prognostic relevance of change in parameters like ΔFM, ΔFFM, ΔLD and ΔFD over 1 year was assessed and compared with baseline model for end stage liver disease(MELD) score. Results Patients with cirrhosis(n = 112) (mean age-41.8 ± 12 years, 58.5% males) were followed up for median duration of 5.7 years(IQR:3.5–5.7), with 5-year survival rate of 77%. On serial BCA, ΔLD(p = 0.029) and ΔFD(p = 0.003) emerged as significant predictors of survival whereas ΔFM(p = 0.479), ΔFFM(p = 0.245) and ΔBMI (p = 0.949) were not. The area under curve of ΔLD and MELD score for predicting survival was 0.636(0.5-0.773) and 0.664(0.555–0.773), respectively. ΔFD < 0.1 over 1 year had sensitivity and specificity of 70.4% and 56.5% to predict poor survival. Combination of ΔFD, MELD and ascites predicted 5-yr survival with an optimism-corrected c-statistic of 0.785. Conclusion Among body composition parameters, changes in bone mineral density correlate best with long-term survival with prognostic relevance similar to that of ascites and MELD score.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.