Malnutrition in Cirrhosis: Contribution and Consequences of Sarcopenia on Metabolic and Clinical Responses

Periyalwar, Pranav; Dasarathy, Srinivasan

doi:10.1016/j.cld.2011.12.009

Cited by 212 publications

(245 citation statements)

References 175 publications

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“…Previous studies demonstrated that several factors, such as Eastern Cooperative Oncology Group PS and CP class A status were predictive factors for patients with HCC receiving sorafenib therapy (11,12). In recent reports, skeletal muscle mass loss was found to be significantly associated with malnutrition and poor liver function (13,14). Our study indicated that skeletal muscle thickness prior to treatment was not associated with PFS or OS in patients treated with sorafenib.…”

Section: Discussionmentioning

confidence: 39%

Significance of psoas muscle thickness as an indicator of muscle atrophy in patients with hepatocellular carcinoma treated with sorafenib

Yamashima

Miyaaki

Honda

et al. 2017

Molecular and Clinical Oncology

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Abstract. Sarcopenia has been reported to be associated with the prognosis of patients with liver cirrhosis and hepatocellular carcinoma (HCC). The aim of the present study was to determine whether sarcopenia was associated with the prognosis of patients with HCC treated with sorafenib. A total of 40 patients with HCC who were treated with sorafenib were evaluated. As an indicator of skeletal muscle mass, transverse psoas muscle thickness (TPMT) was measured on computed tomography images at the level of the umbilicus prior to treatment initiation and after 1-3 months of treatment. Pre-TPMT/height was not associated with progression-free survival (PFS) or overall survival (OS). The change in TPMT/height prior to and following treatment was also not associated with PFS; however, the change of TPMT/height was an independent factor affecting OS (P=0.020). A total of 40 patients were divided into two groups depending on the degree of TPMT/height loss (mild and severe muscle atrophy groups). Patients with mild muscle atrophy exhibited a significantly longer OS compared with patients with severe muscle atrophy (P=0.045). Thus, the change in skeletal muscle thickness calculated as TPMT/height may be a simple predictor of survival for patients with HCC treated with sorafenib.

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Section: Discussionmentioning

confidence: 39%

Significance of psoas muscle thickness as an indicator of muscle atrophy in patients with hepatocellular carcinoma treated with sorafenib

Yamashima

Miyaaki

Honda

et al. 2017

Molecular and Clinical Oncology

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“…Generally, skeletal muscle mass is regulated depending on the balance between protein synthesis and protein breakdown (21). Patients with HCC often have underlying liver cirrhosis (LC), and skeletal muscle loss is a major characteristic of protein energy malnutrition in patients with LC (22,23). Age-associated sarcopenia is defined as primary sarcopenia, whereas LC is one of the causes of secondary sarcopenia (19,22,23).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with HCC often have underlying liver cirrhosis (LC), and skeletal muscle loss is a major characteristic of protein energy malnutrition in patients with LC (22,23). Age-associated sarcopenia is defined as primary sarcopenia, whereas LC is one of the causes of secondary sarcopenia (19,22,23). Although commonly observed, malnutrition is frequently underdiagnosed or overlooked, and it is poorly characterized in patients with HCC and LC complications (21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

“…Age-associated sarcopenia is defined as primary sarcopenia, whereas LC is one of the causes of secondary sarcopenia (19,22,23). Although commonly observed, malnutrition is frequently underdiagnosed or overlooked, and it is poorly characterized in patients with HCC and LC complications (21)(22)(23). In addition, to the best of our knowledge, although sarcopenia has been reported to be an adverse predictor in patients with HCC who may have a potential for curative therapy such as surgical resection, as well as in patients with several malignancies other than HCC, there have been no studies regarding the impact of sarcopenia on clinical outcomes in patients with HCC undergoing sorafenib therapy (18,(24)(25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy

et al. 2017

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Abstract. The present study aimed to examine the impact of sarcopenia, defined as low muscle mass on computed tomography (CT), prior to sorafenib therapy on the clinical outcomes of patients with hepatocellular carcinoma (HCC) receiving sorafenib therapy. In total, 232 patients with unresectable HCC (median age, 72 years) were analyzed, and the extent of sarcopenia was assessed using CT. Cross-sectional areas (cm 2 ) of the skeletal muscles at the third lumbar vertebra level were determined by manual outlining on the CT images. The cross-sectional areas were normalized for height [skeletal rates, progression-free survival (PFS) rates and best treatment response of the sarcopenia group were retrospectively compared with those of the non-sarcopenia group, and the factors associated with OS and PFS were examined. Sarcopenia was observed in 151 patients (65.1%). There were 165 patients with Child-Pugh A and 67 with Child-Pugh B cirrhosis. In the sarcopenia group, the median treatment duration was 66 days, whereas in the non-sarcopenia group it was 103 days (P=0.001). The median OS time was 174 days in the sarcopenia group and 454 days in the non-sarcopenia group (P<0.0001). The median PFS was 77 days in the sarcopenia group and 106 days in the non-sarcopenia group (P=0.0131). Multivariate analysis identified sarcopenia to be an independent predictor of OS (hazard ratio, 0.365; P<0.0001). The objective response rate and disease control rate in the sarcopenia group were significantly lower, compared with those in the non-sarcopenia group (P=0.0146 and P=0.0151, respectively). In conclusion, sarcopenia may be an indicator of poor clinical course in patients with HCC receiving sorafenib. IntroductionHepatocellular carcinoma (HCC) is one of the major causes of cancer-associated mortality worldwide, accounting for 5.7% of all newly diagnosed malignancies (1-5). The annual incidence rates of HCC are the highest in East Asia and Sub-Saharan Africa, where >80% of all known cases develop (1-5). Advances in treatments for HCC during the last few decades markedly improved the prognosis of the disease (1,2,4,5). However, a curative therapy such as surgical resection may be applied to a limited number (<20%) of patients with HCC (5,6). Sorafenib is a multi-kinase inhibitor that suppresses cancer growth and cell proliferation (7,8). Two pivotal randomized phase III studies, namely the Sorafenib HCC Assessment Randomized Protocol study (7)

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“…Furthermore, it has been shown that healthy patients require 3 days of fasting to enter a starvation state whereas patients with cirrhosis will switch to gluconeogenesis from amino acids after only an overnight fast [28] . Sarcopenia, or loss of skeletal muscle mass, is the most common complication in cirrhosis and is thought to be a major contributor to the development of malnutrition in cirrhosis [29] . Development of Iiames J et al .…”

Section: Pathogenesis Of Malnutrition In Older Adults With Cirrhosismentioning

confidence: 99%

Protein Recommendations for Older Adults with Cirrhosis: A Review

Iiames

Logomarsino

2015

Journal of Gastroenterology and Hepatology Research

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Protein intake has a key role in liver cirrhosis in older adults. However, types and amounts of protein intake in cirrhosis have been controversial. The aim of this paper is to investigate the optimal protein intake for management of cirrhosis and prevention of hepatic encephalopathy in older adults. Protein restriction of 0.6 g/kg/d has traditionally been used as medical nutrition therapy in liver cirrhosis. However, recent evidence has shown that protein restrictions have many negative consequences for older adults with cirrhosis. Current research indicates protein intakes of 1.2-1.5 g/ kg/d in liver cirrhosis; however, many older adults do not consume this amount. Strategies to help increase protein intake and manage cirrhosis include ensuring adequate protein at every meal through either regular intake or supplementation, protein supplementation prior to bedtime or overnight, and supplementation with branchedchain amino acids. An emphasis on vegetable protein versus animal protein is probably not an advantageous treatment option because of lack of conclusive evidence regarding benefits and potential negative side effects. and progression of chronic liver disease and cirrhosis.There are several different factors that naturally occur in older adulthood that help contribute to the development of chronic liver disease and cirrhosis. After reaching maximum size in early adulthood, the liver steadily decreases in both size and the amount of blood flow it receives, leading to decreased function and efficiency over time [10] . Also, increased ammonia production and bacterial overgrowth are common in older adulthood, both of which are thought to play a key role in development of hepatic encephalopathy [11] . Older adults tend to have chronic constipation, intestinal dysmotility, and increased colonic transit time, which predisposes them to increased ammonia production [12] . Finally, older adulthood is associated with a higher incidence of diabetes, which is strongly correlated to progression of liver cirrhosis [13] . Pathogenesis of malnutrition in older adults with cirrhosisIt is estimated that 20% of patients with compensated cirrhosis and 60% of patients with decompensated cirrhosis have malnutrition [14] . In older adults, protein energy malnutrition is associated with high health care costs, increased frequency of infection and bedsores, increased morbidity and mortality, and poor physical functioning [4,5] . In canine trials, poor nutritional status has been shown to encourage the development of hepatic encephalopathy [15] . In addition, malnutrition in cirrhosis is positively associated with old age [14] . Multiple factors help contribute to the development of malnutrition in older adults with cirrhosis, including inadequate intake, altered absorption, sarcopenia, and altered metabolism. All causes must be explored and taken into consideration when developing treatment and prevention strategies.In older adults, food intake naturally decreases over time [16] , which promotes the development of malnutri...

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Malnutrition in Cirrhosis: Contribution and Consequences of Sarcopenia on Metabolic and Clinical Responses

Cited by 212 publications

References 175 publications

Significance of psoas muscle thickness as an indicator of muscle atrophy in patients with hepatocellular carcinoma treated with sorafenib

Significance of psoas muscle thickness as an indicator of muscle atrophy in patients with hepatocellular carcinoma treated with sorafenib

Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy

Protein Recommendations for Older Adults with Cirrhosis: A Review

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