Characterization of body composition and definition of sarcopenia in patients with alcoholic cirrhosis: A computed tomography based study

Benjamin, Jaya; Shasthry, Varsha; Kaal, Chetan Ramesh; Anand, Lovkesh; Bhardwaj, Ankit; Pandit, Vanshja; Arora, Ankur; Rajesh, Sasidharan; Pamecha, Viniyendra; Jain, Vikas; Kumar, Guresh; Loria, Anthony; Puri, Puneet; Joshi, Yogendra; Sarin, Shiv Kumar

doi:10.1111/liv.13509

Cited by 56 publications

(50 citation statements)

References 33 publications

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“…Indeed, cirrhosis is a state of accelerated starvation that is believed to be responsible for the reduced skeletal and adipose tissue mass. 1,8,42 This study, in a large group of patients, confirms the differential response between subcutaneous and visceral fat after TIPSS placement, which has been suggested in previous studies. 1,34 Moreover, our study provides original data on the evolution of fat distribution and suggests that it is more likely than sarcopenia to rapidly change in response to slight or temporary HVPG variations.…”

Section: Discussionsupporting

confidence: 88%

Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT‐based surveillance

Artru

Miquet

Azahaf

et al. 2020

Aliment Pharmacol Ther

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SummaryBackgroundBody composition may be modified after improvement of portal hypertension (PHT) by transjugular intrahepatic portosystemic shunt (TIPSS) insertion.AimsTo evaluate changes in body composition following TIPSS placement, their relationship with radiological TIPSS patency and function, and the predictive value of these parametersMethodsWe retrospectively included 179 patients with cirrhosis who underwent TIPSS placement in our centre for severe PHT from 2011 to 2017. CT scan‐based surveillance was performed at baseline, 1‐3 (M1‐M3) and 6 months (M6).ResultsThe median model for end‐stage liver disease (MELD) score was 11.4 (8.8‐15.1) and Child‐Pugh score 8 (7‐9). Only the MELD score (HR 1.14, 95% CI 1.08‐1.20) and sarcopenia assessed by transversal right psoas muscle thickness at the umbilical level/height (TPMPT/height) (HR 0.86, 95% CI 0.79‐0.96) were independently associated with 6‐month mortality on multivariate analysis. After TIPSS insertion, TPMT/height increased from 19 mm/m (baseline) to 19.6 mm/m (M1‐M3, P = 0.004) and 21.1 mm/m (M6, P < 0.0001). The improvement and its extent were dependent on the radiological patency and dysfunction of TIPSS. Subcutaneous fat surface (SCFS) increased from 183.4 to 193 cm2 (P < 0.0001) and 229.8 cm2 (P < 0.0001), respectively. We observed a decrease in visceral fat surface (VFS) between baseline and M1‐M3 (163.5‐140.5 cm2 [P < 0.0001]), but not between M1‐M3 and M6 (140.5‐141.2 cm2 [P = 0.9]). SCFS and VFS did not seem to be modified by radiological TIPSS patency and dysfunction.ConclusionsSarcopenia is independently associated with 6‐month outcome and improves after TIPSS placement, together with an inverse evolution of subcutaneous and visceral fat. TIPSS not only treats PHT but also improves body composition.

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Section: Discussionsupporting

confidence: 88%

Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT‐based surveillance

Artru

Miquet

Azahaf

et al. 2020

Aliment Pharmacol Ther

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“…Currently, CT is considered one of the most accurate methods for analyzing quantitative and qualitative changes in body composition, especially when investigating skeletal muscle mass and distinguishing adipose tissue in different body compartments (12,20). A dedicated computer software is required to quantify and determine components in different tissues.…”

Section: Discussionmentioning

confidence: 99%

“…A large number of studies have used abdominal CT to quantify body composition parameters in a variety of clinical situations, such as renal (11) and hepatic (12,13) disease, obesity (3) and cancer (14)(15)(16). Different software programmes have been used to perform these body composition analyses.…”

Section: Introductionmentioning

confidence: 99%

Agreement between software programmes of body composition analyses on abdominal computed tomography scans of obese adults

Barbalho¹,

Rocha²,

Medeiros³

et al. 2019

Archives of Endocrinology and Metabolism

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Objective: A large number of studies have used abdominal computed tomography (CT) to quantify body composition, and different software programmes have been used to perform these analyses. Thus, this comparison is important to enable researchers to know the performance of more accessible software. Subjects and methods: Fifty-four abdominal CT scans of obese (BMI 30 to 39.9 kg/m²), sedentary adults (24-41 years) patients from a Brazilian single center were selected. Two software programs were compared: Slice-O-Matic (Tomovision, Canada) version 5.0 and OsiriX version 5.8.5. The body composition analysis were segmented using standard Hounsfield unit (HU) (adipose tissue:-190 to +30 and skeletal muscle:-29 to +150) and measured at the mid third lumbar vertebra (L3) level on a slice showing both transversal processes. Bland-Altman limits of agreement analyses were used to assess the level of agreement between Slice-O-Matic and OsiriX. Results: A total of fiftyfour participants were evaluated, with majority women (69%), mean of age 31.3 (SD 6.5) years and obesity grade I most prevalent (74.1%). The agreement, in Bland-Altman analysis, between Slice-O-Matic and OsiriX analisys for the muscle mass tissue, visceral adipose tissue and subcutaneous adipose tissue were excellent (≥ 0.954) with P-values < 0.001. Conclusion: These findings show that Slice-O-Matic and OsiriX softwares agreement in measurements of skeletal muscle and adipose tissue and sarcopenia diagnosis in obese patients, suggesting good applicability in studies with body composition in this population and clinical practice.

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“…In fact, muscle fatty degeneration and decrease of muscle mass measured by CT occur predominantly in advanced cirrhosis [ 13 , 16 ]. In fact, in a study by Benjamin et al, the prevalence of sarcopenia identified on CT measures was 12.8% in patients with alcoholic liver cirrhosis [ 39 ]. Furthermore, the authors observed significant differences regarding muscle area and muscle index between healthy persons and patients with alcoholic liver cirrhosis [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Apparent Diffusion Coefficient Is a Novel Imaging Biomarker of Myopathic Changes in Liver Cirrhosis

Surov

Paul

Schob

et al. 2018

JCM

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Diffusion weighted imaging can provide information regarding tissue composition and can quantitatively characterize different pathological changes by means of apparent diffusion coefficient (ADC). The study comprised of 114 patients with liver cirrhosis—22 women and 92 men with a mean age of 56.5 ± 9.0 years. In all patients, the Model for End Stage-Liver Disease (MELD) score was calculated. Furthermore, 12 healthy persons (5 women, 7 men), mean age, 42.1 ± 16.2 years, were investigated as a control group. In all cases, magnetic resonance imaging of the liver/trunk was performed using different 3T scanners and diffusion weighted images were obtained with a multi-shot SE-EPI sequence. In all cases, polygonal regions of interest were manually drawn on the ADC maps along the contours of the iliopsoas and paravertebral muscles. The comparison of ADC values in groups was performed by Mann-Whitney-U tests. The association between ADC and MELD score was calculated by Spearman’s rank correlation coefficient. ADC values of the skeletal musculature were statistically much higher in comparison to those in the control group: 1.85 ± 0.46 × 10−3 mm2 s−1 vs. 1.23 ± 0.12 × 10−3 mm2 s−1, p = 0.001. ADC values showed statistically significant correlation with the MELD score (r = 0.473, p = 0.0001). Furthermore, ADC values differed between the subgroups with different values of the MELD score. ADC values correlated slightly with lactate dehydrogenase (LDH) (r = 0.381, p = 0.0001) and tended to correlate with C-reactive protein (CRP) (r = 0.171, p = 0.07) and alanine aminotransferase (ALAT) (r = −0.167, p = 0.076). ADC can reflect muscle changes in liver cirrhosis and shows statistically significant correlation with the MELD score. Therefore, ADC can be used as an imaging biomarker of myopathic changes in liver cirrhosis.

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Characterization of body composition and definition of sarcopenia in patients with alcoholic cirrhosis: A computed tomography based study

Abstract: Compensated ALC have increased adiposity and relatively preserved muscularity but decompensation leads to loss of both muscle and fat mass. Prevalence of sarcopenia, based on derived ethnic cut-offs was 12.8%.

Cited by 56 publications

References 33 publications

Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT‐based surveillance

Consequences of TIPSS placement on the body composition of patients with cirrhosis and severe portal hypertension: a large retrospective CT‐based surveillance

Agreement between software programmes of body composition analyses on abdominal computed tomography scans of obese adults

Apparent Diffusion Coefficient Is a Novel Imaging Biomarker of Myopathic Changes in Liver Cirrhosis

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