Handgrip strength as a predictor of bone mineral density in outpatients with cirrhosis

Santos, L.; Lima, Tiago Barbalho; Augusti, Laís; Franzoni, L.; Yamashiro, Fábio da Silva; Bolfi, Fernanda; Nunes, Vânia dos Santos; Dorna, Mariana de Souza; Oliveira, Cássio Vieira de; Caramori, Carlos Antonio; Silva, Giovanni Faria; Romeiro, Fernando Gomes

doi:10.1111/jgh.13062

Cited by 14 publications

(21 citation statements)

References 20 publications

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“…SGA identified malnutrition in 41% of the patients with most of them being considered moderately malnourished. Those findings were consistent with recent studies on this issue (9,17,18,21) . Furthermore, these results clearly shows that patients assessed in a ward setting present more frequent and severe malnutrition whatever the tool used to assess nutritional status.…”

Section: Discussionsupporting

confidence: 83%

“…Nevertheless, a significant number of death patients were CTP A, which could mean that even in the presence of mild liver impairment, malnutrition may have a negative impact in the outcome. As it was also shown previously (21) , TSF revealed to be the most sensitive anthropometric parameter to identify PCM and appeared to predict poor outcome in CLD patients identifying up to two thirds of patients who died and displayed severe malnutrition.…”

Section: Discussionmentioning

confidence: 70%

“…Several reported studies have shown that functional status defined by handgrip strength correlates with severity of malnutrition and clinical outcome in different disease states (9,17,18,21) . More than a half of the tested patients in this sample displayed deficient/ low values in dynamometry, which was associated with the high prevalence of PCM detected in CLD patients as it was previously reported (4,8,13,14,19,23,27) .…”

Section: Discussionmentioning

confidence: 99%

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Outcome and Nutritional Assessment of Chronic Liver Disease Patients Using Anthropometry and Subjective Global Assessment

Nunes

Santos

Barosa

et al. 2017

Arq. Gastroenterol.

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-Background -Protein-calorie malnutrition is common in chronic liver disease (CLD) but adequate clinical tools for nutritional assessment are not defined. Objective -In CLD patients, it was aimed: 1. Characterize protein-calorie malnutrition; 2. Compare several clinical, anthropometric and functional tools; 3. Study the association malnutrition/CLD severity and malnutrition/outcome. Methods -Observational, prospective study. Consecutive CLD ambulatory/hospitalised patients were recruited from 01-03-2012 to 31-08-2012, studied according with age, gender, etiology, alcohol consumption and CLD severity defined by Child-Turcotte-Pugh. Nutritional assessment used subjective global assessment, anthropometry, namely body-mass index (BMI), triceps skinfold, mid upper arm circumference, mid arm muscular circumference and handgrip strength. Patients were followed during two years and survival data was recorded. Results -A total of 130 CLD patients (80 men), aged 22-89 years (mean 60 years) were included. Most suffered from alcoholic cirrhosis (45%). Hospitalised patients presented more severe disease (P<0.001) and worst nutritional status defined by BMI (P=0.002), mid upper arm circumference (P<0.001), mid arm muscular circumference (P<0.001), triceps skinfold (P=0.07) and subjective global assessment (P<0.001). A third presented deficient/low handgrip strength. Alcohol consumption (P=0.03) and malnutrition detected by BMI (P=0.03), mid upper arm circumference (P=0.001), triceps skinfold (P=0.06), mid arm muscular circumference (P=0.02) and subjective global assessment (P<0.001) were associated with CLD severity. From 25 patients deceased during follow-up, 17 patients were severely malnourished according with triceps skinfold. Malnutrition defined by triceps skinfold predicted mortality (P<0.001). Conclusion -Protein-calorie malnutrition is common in CLD patients and alcohol plays an important role. Triceps skinfold is the most efficient anthropometric parameter and is associated with mortality. Nutritional assessment should be considered mandatory in the routine care of CLD patients.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Outcome and Nutritional Assessment of Chronic Liver Disease Patients Using Anthropometry and Subjective Global Assessment

Nunes

Santos

Barosa

et al. 2017

Arq. Gastroenterol.

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“…Therefore, some authors have advocated that bone densitometry must be part of the evaluation performed before orthotopic liver transplantation (OLT) [2, 7]. Furthermore, recent data have suggested that bone status must be assessed in all cirrhotic patients [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

“…Then, other studies assessed patients before and after OLT [16, 17]. Most of them have shown that osteoporosis is common among all cirrhotic patients regardless of the liver disease etiology or the degree of liver impairment [7, 9, 18, 19]. Thus, the aim of this review was to evaluate the physiopathology, the impact, the diagnosis, and the management of osteoporosis in patients with liver cirrhosis, in order to show the more recent data and establish some comparisons between cirrhotic patients under different conditions.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Cirrhosis-Related Osteoporosis

Santos

Romeiro

2016

BioMed Research International

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Management of cirrhosis complications has greatly improved, increasing survival and quality of life of the patients. Despite that, some of these complications are still overlooked and scarcely treated, particularly those that are not related to the liver. This is the case of osteoporosis, the only cirrhosis complication that is not solved after liver transplantation, because bone loss often increases after immunosuppressant therapy. In this review, the definitions of bone conditions in cirrhotic patients are analyzed, focusing on the more common ones and on those that have the largest impact on this population. Risk factors, physiopathology, diagnosis, screening strategies, and treatment of osteoporosis in cirrhotic patients are discussed, presenting the more striking data on this issue. Therapies used for particular conditions, such as primary biliary cirrhosis and liver transplantation, are also presented.

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Bone microarchitecture and bone turnover in hepatic cirrhosis

et al. 2019

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Summary Liver cirrhosis leads to bone loss. To date, information on bone quality (three-dimensional microarchitecture) and, thus, bone strength is scarce. We observed decreased bone quality at both assessed sites, independent of disease severity. Therefore, all patients should undergo early-stage screening for osteoporosis. Introduction Recent studies found low bone mineral density in cirrhosis, but data on bone microstructure are scarce. This study assessed weight-bearing and non-weight-bearing bones in patients with cirrhosis and healthy controls. The primary objective was to evaluate trabecular and cortical microarchitecture. Methods This was a single-center study in patients with recently diagnosed hepatic cirrhosis. Thirty-two patients and 32 controls participated in this study. After determining the type of cirrhosis, the parameters of bone microarchitecture were assessed by high-resolution peripheral quantitative computed tomography. Results Both cortical and trabecular microarchitectures showed significant alterations. At the radius, trabecular bone volume fraction was 17% lower (corrected p = 0.028), and, at the tibia, differences were slightly more pronounced. Trabecular bone volume fraction was 19% lower ( p = 0.024), cortical bone mineral density 7% ( p = 0.007), and cortical thickness 28% ( p = 0.001), while cortical porosity was 32% higher ( p = 0.023), compared to controls. Areal bone mineral density was lower (lumbar spine − 13%, total hip − 11%, total body − 9%, radius − 17%, and calcaneus − 26%). There was no correlation between disease severity and microarchitecture. Areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA) correlated well with parameters of cortical and trabecular microarchitecture. Conclusions Hepatic cirrhosis deteriorates both trabecular and cortical microarchitecture, regardless of disease severity. Areal bone mineral density is diminished at all sites as a sign of generalized affection. In patients with hepatic cirrhosis, regardless of its origin or disease severity, aBMD measurements are an appropriate tool for osteologic screening.

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Handgrip strength as a predictor of bone mineral density in outpatients with cirrhosis

Cited by 14 publications

References 20 publications

Outcome and Nutritional Assessment of Chronic Liver Disease Patients Using Anthropometry and Subjective Global Assessment

Outcome and Nutritional Assessment of Chronic Liver Disease Patients Using Anthropometry and Subjective Global Assessment

Diagnosis and Management of Cirrhosis-Related Osteoporosis

Bone microarchitecture and bone turnover in hepatic cirrhosis

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