A comparison of skinfold anthropometry and dual-energy X-ray absorptiometry for the evaluation of body fat in cirrhotic patients

Fiore, Piera Filomena; Merli, Manuela; Andréoli, A.; Lorenzo, Antonino De; Masini, Alice; Ciuffa, L.; Valeriano, Valentina; Balotta, M.T.; Riggio, O.

doi:10.1016/s0261-5614(99)80014-4

Cited by 37 publications

(18 citation statements)

References 14 publications

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“…The sum of the tricep, bicep, subscapular, and suprailiac skinfolds was used to assess percentage body fat according to previously published age-and sexspecific tables (26). This method has been shown to have comparable results with dual energy X-ray absorptiometry in patients with cirrhosis without overt fluid retention (27). Fat-free mass (FFM) was calculated as body weight minus fat mass.…”

Section: Assessment Of Nutritional Statusmentioning

confidence: 99%

Altered postprandial glucose, insulin, leptin, and ghrelin in liver cirrhosis: correlations with energy intake and resting energy expenditure

Kalaitzakis

Bosæus

Öhman

et al. 2007

The American Journal of Clinical Nutrition

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Background: Liver cirrhosis is associated with reduced energy intake and increased resting energy expenditure. Objective: We aimed to investigate the possible role of glucose, insulin, leptin, and ghrelin in the pathogenesis of these alterations. Design: Nutritional status, energy intake, resting energy expenditure, and fasting glucose, insulin, and leptin were assessed in 31 patients with cirrhosis. Postprandial glucose, insulin, C-peptide, leptin, and ghrelin responses were studied in a subgroup of patients after a standard meal. Ten healthy subjects served as controls. Results: Patients with cirrhosis had a lower energy intake (P 0.05), higher resting energy expenditure (P 0.05), higher fasting leptin (P 0.05), and higher insulin resistance (P 0.001) than did the healthy control subjects. In the patients with cirrhosis, fasting leptin was negatively correlated with resting energy expenditure (r ҃ Ҁ0.38, P 0.05) but not with energy intake. In control subjects, leptin was negatively correlated with energy intake (r ҃ Ҁ0.72, P 0.05) but not with resting energy expenditure. The patients with cirrhosis had higher postprandial glucose (P 0.001) and lower ghrelin (P 0.05) concentrations at 4 h postprandially than did the control subjects. The increase in ghrelin from its minimal postmeal value to 4 h postmeal was negatively correlated (r ҃ Ҁ0.66, P ҃ 0.014) with weight loss in the patients with cirrhosis. Energy intake was negatively correlated (r ҃ Ҁ0.42, P 0.01) with the postprandial increase in glucose. Conclusions: In cirrhosis, altered postprandial glucose and ghrelin are associated with reduced energy intake and weight loss, respectively, and the effects of leptin on energy intake and expenditure seem to be altered. Insulin resistance might be involved in these altered postprandial responses.Am J Clin Nutr 2007;85: 808 -15.

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Section: Assessment Of Nutritional Statusmentioning

confidence: 99%

Altered postprandial glucose, insulin, leptin, and ghrelin in liver cirrhosis: correlations with energy intake and resting energy expenditure

Kalaitzakis

Bosæus

Öhman

et al. 2007

The American Journal of Clinical Nutrition

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“…Anthropometric measurements have been proposed as the most practical objective indices of nutritional depletion in chronic liver disease [9] and they are widely used in the nutritional evaluation of patients with cirrhosis [9,[11][12][13][14]. In study III, skinfold thickness at the biceps, subscapular, and suprailiac sites were also measured and percent body fat was calculated [143], a method shown to have comparable results with dual energy x-ray absorptiometry in cirrhotics without overt fluid retention [144]. Patients were considered malnourished when triceps skinfold thickness and/or mid-arm muscle circumference were below the 10 th percentile (I) or the 5 th percentile (II,III), according to standard tables for the Swedish population based on age and sex [145], and/or if BMI was < 20 kg·m -2 [146].…”

Section: Nutritional Status Assessment (I II Iii)mentioning

confidence: 99%

Intestinal permeability in cirrhotic patients with and without ascites

Kalaitzakis

Johansson

Bjarnason³

et al. 2006

Scandinavian Journal of Gastroenterology

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Malnutrition is a common finding in patients with liver cirrhosis. Malnutrition has been shown to be associated with increased morbidity and mortality. Its pathogenesis remains unclear but both poor dietary intake and increased energy expenditure have been reported.Spontaneous bacterial peritonitis is an important clinical problem in cirrhotics. It may occur as a consequence of repeated access of bacteria from the intestinal lumen (translocation) to the mesenteric lymph nodes. One of the mechanisms proposed to explain bacterial translocation in cirrhosis includes increased intestinal permeability.The aims of the present study were to evaluate GI symptoms in cirrhotic patients and their possible relation to nutritional status, to assess whether gastric sensorimotor dysfunction or metabolic disturbances are associated with reduced food intake, and to investigate the role of ascites in intestinal permeability in patients with liver cirrhosis.Gastrointestinal symptoms and health-related quality of life (HRQOL) were assessed with the aid of two questionnaires. Gastric sensorimotor function was measured by means of an electronic barostat. Food intake, as assessed with a food diary, was related to fasting and postprandial glucose, insulin, leptin, and ghrelin concentrations. Intestinal permeability was evaluated by a 51 Cr-EDTA permeability test. Cirrhotics were found to have increased severity of GI symptoms compared with reference values from the general population. A relationship between GI symptoms and compromised HRQOL as well as weight loss was observed.Proximal stomach relaxation to a meal was increased in patients with liver cirrhosis as compared with healthy controls but the relation between gastric accommodation and energy intake was found to be disturbed in these patients. Gastric sensitivity to distension was shown to be related to GI symptom severity and to liver cirrhosis severity scores.Patients with liver cirrhosis exhibited higher postprandial insulin and glucose concentrations compared to controls. Cirrhotics had higher fasting leptin that fell significantly postmeal and they showed an attenuated increase of ghrelin before the next expected meal. Altered glucose and hormonal levels in patients with cirrhosis were associated with poor food intake.Only a few patients with cirrhosis had increased intestinal permeability, as assessed by a 51 Cr-EDTA test, which was not influenced to a major extent by ascites. Conclusions: In patients with liver cirrhosis GI symptom severity is high and it is associated with impaired HRQOL and weight loss. Gastric accommodation is not involved in the poor food intake observed in cirrhotics and gastric sensitivity seems to be a relevant factor for GI symptom generation in these patients. Altered postprandial glucose, leptin, and ghrelin levels are correlated to reduced energy intake in this patient group. Increased intestinal permeability is probably of limited importance in the pathophysiology of bacterial infections in patients with liver cirrhosis and ascites.

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“…Although anthropometry may be affected by the presence of severe water retention, some studies have shown a good correlation between the assessment of body composition through anthropometric measurements (arm-muscle circumference and triceps skinfold) and more sophisticated techniques such as dual exchange X-ray absorption. 30,31 The arm-muscle circumference and triceps skinfold thickness have also been shown to correlate with mortality in cirrhotic patients. 23,24 To overcome the difficulty to assess the nutritional status in patients with chronic liver disease, some authors have applied a combination of different parameters to obtain what is widely known as the 'Subjective Global Assessment (SGA)' of nutrition.…”

Section: Main Causes Of Malnutrition and Methods To Recognize Nutritimentioning

confidence: 99%

Nutritional Status and Liver Transplantation

Merli¹,

Giusto²,

Giannelli³

et al. 2011

Journal of Clinical and Experimental Hepatology

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Chronic liver disease has a profound effect on nutritional status and undernourishment is almost universally present in patients with end-stage liver disease undergoing liver transplantation. In the last decades, due to epidemiological changes, a trend showing an increase in patients with end-stage liver disease and associated obesity has also been reported in developed countries. Nutrition abnormalities may influence the outcome after transplantation therefore, the importance to carefully assess the nutritional status in the work-up of patients candidates for liver transplantation is widely accepted. More attention has been given to malnourished patients as they represent the greater number. The subjective global nutritional assessment and anthropometric measurements are recognized in current guidelines to be adequate in identifying those patients at risk of malnutrition. Cirrhotic patients with a depletion in lean body mass and fat deposits have an increased surgical risk and malnutrition may impact on morbidity, mortality and costs in the post-transplantation setting. For this reason an adequate calorie and protein intake should always be ensured to malnourished cirrhotic patient either through the diet, or using oral nutritional supplements or by enteral or parenteral nutrition although studies supporting the efficacy of nutritional supplementation in improving the clinical outcomes after transplantation are still scarce. When liver function is restored, an amelioration in the nutritional status is expected. After liver transplantation in fact dietary intake rapidly normalizes and fat mass is progressively regained while the recovery of muscle mass can be slower. In some patients unregulated weight gain may lead to over-nutrition and may favor metabolic disorders (hypertension, hyperglycemia, hyperlipidemia). This condition, defined as 'metabolic syndrome', may play a negative role on the overall survival of liver transplant patients. In this report we review data on nutrition and liver transplantation. © 2011 INASL

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A comparison of skinfold anthropometry and dual-energy X-ray absorptiometry for the evaluation of body fat in cirrhotic patients

Cited by 37 publications

References 14 publications

Altered postprandial glucose, insulin, leptin, and ghrelin in liver cirrhosis: correlations with energy intake and resting energy expenditure

Altered postprandial glucose, insulin, leptin, and ghrelin in liver cirrhosis: correlations with energy intake and resting energy expenditure

Intestinal permeability in cirrhotic patients with and without ascites

Nutritional Status and Liver Transplantation

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