Association between pre‐sarcopenia, sarcopenia, and bone mineral density in patients with chronic hepatitis C

Abstract

BackgroundPreserved skeletal muscle is essential for the maintenance of healthy bone. Loss of bone mineral density (BMD) and muscle strength, considered a predictor of BMD, have been demonstrated in patients with cirrhosis, but they are poorly studied in chronic hepatitis C (CHC) without cirrhosis. Thus, we aimed to evaluate the prevalence of low BMD and its association with body composition, muscle strength, and nutritional status in CHC.MethodsOne hundred and four subjects [mean age, 50.5 ± 11.3 years; 75.0% males; 67.3% non‐cirrhotic; and 32.7% with compensated cirrhosis] with CHC, prospectively, underwent scanning of the lean tissue, appendicular skeletal muscle mass (ASM), fat mass, lumbar spine, hip, femoral neck, and whole‐body BMD by dual‐energy X‐ray absorptiometry. Muscle strength was assessed by dynamometry. Sarcopenia was defined by the presence of both low, ASM/height2 (ASMI) and low muscle strength according to the European Working Group on Sarcopenia in Older People criteria. The cut‐off points for low ASMI and low muscle strength, for women and men, were < 5.45 and < 7.26 kg/m2 and < 20 and < 30 kg, respectively. According to the adopted World Health Organization criteria in men aged > 50 years, the T‐score of osteopenia is between −1.0 and −2.49 standard deviation (SD) below the young average value and of osteoporosis is ≥−2.5 SD below the young normal mean for men, and the Z‐score of low bone mass is ≤−2.0 SD below the expected range in men aged < 50 years and women in the menacme. Nutritional status evaluation was based on the Controlling Nutritional Status score.ResultsLow BMD, low muscle strength, pre‐sarcopenia, sarcopenia, and sarcopenic obesity were observed in 34.6% (36/104), 27.9% (29/104), 14.4% (15/104), 8.7% (9/104), and 3.8% (4/104) of the patients, respectively. ASMI was an independent predictor of BMD (P < 0.001). Sarcopenia was independently associated with bone mineral content (P = 0.02) and malnutrition (P = 0.01). In 88.9% of the sarcopenic patients and in all with sarcopenic obesity, BMI was normal. The mid‐arm muscle circumference was positively correlated with ASMI (r = 0.88; P < 0.001).ConclusionsThis is the first study to demonstrate that ASM is an independent predictor of BMD in CHC. Mid‐arm muscle circumference coupled with handgrip strength testing should be incorporated into routine clinical practice to detect low muscle mass, which may be underdiagnosed when only BMI is used. These findings may influence clinical decision‐making and contribute to the development of effective strategies to screen the musculoskeletal abnormalities in CHC patients, independently of the stage of the liver disease.

Prediction of 5-year mortality risk by malnutrition according to the GLIM format using seven pragmatic approaches to define the criterion of loss of muscle mass

“…Assessed (cm) with a measuring tape on the dominant side (e.g., right arm in right-handed individuals) in individuals in sitting position with lower arm resting on a plain surface, 90º-elbow flexion at the point of bigger circumference without pressing the tissue, as recommended by the Report of the WHO Expert Committee for the use of and interpretation of anthropometry in older people [35] and reported by Frisancho et al, [40]. The lowest quartile (a value < 21 cm) was computed for SarcoPhAge and used as threshold [24].…”

Cachexia as a common characteristic in multiple chronic disease

“…As previously mentioned, cachexia is usually reported as a complication of chronic diseases, including chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, chronic hepatitis and cirrhosis, diabetes mellitus, chronic kidney disease (CKD), and chronic heart failure (CHF) . A hypothesis has been proposed that independent of the individual chronic disease, the wasting process follows a common final metabolic pattern.…”

High-density lipoprotein cholesterol for the prediction of mortality in cirrhosis with portal vein thrombosis: a retrospective study

“…The efflux capacity of HDL-C can be used to predict risks in cirrhosis patients [21]. Moreover, nutrition state deterioration usually occurs in the decompensated stage of liver diseases [24, 25]. Inadequate caloric and protein intake and progressive depletion of skeletal muscle observed in patients with chronic liver disorders lead to insufficient synthesis of lipoproteins and cholesterols.…”