Relationship Between Total Body Protein and Cross‐Sectional Skeletal Muscle Area in Liver Cirrhosis Is Influenced by Overhydration

Wells, Cameron I.; McCall, John; Plank, Lindsay D.

doi:10.1002/lt.25314

Cited by 22 publications

(23 citation statements)

References 51 publications

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“…In children with chronic diseases, imaging is often performed as a part of their routine clinical care, making the assessment of SMM possible without additional costs and radiation exposure. A recent adult study has demonstrated that total body fluid status may influence the determination of SMM derived from cross‐sectional CT/MRI . This may be applicable to pediatric clinical populations that are prone to altered total body fluid status and hence warrant further study.…”

Section: Discussionmentioning

confidence: 93%

“…A recent adult study has demonstrated that total body fluid status may influence the determination of SMM derived from cross-sectional CT/MRI. 29 This may be applicable to pediatric clinical populations that are prone to altered total body fluid status and hence warrant further study. DEXA is recommended as one of the methods to identify sarcopenia in adults.…”

Section: Body Composition Methodsmentioning

confidence: 99%

“…22 Although PMA has been found to be an easy marker of sarcopenia, controversies exist on whether a single psoas muscle is sufficient to reflect total SMM. [27][28][29] In a study that used BIA, SMM was estimated through predictive equation. 23 No standardized definition for sarcopenia and SO was observed.…”

Section: Pediatric Sarcopenia Assessment and Definitionmentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Sarcopenia: A Paradigm in the Overall Definition of Malnutrition in Children?

Ooi

Thompson‐Hodgetts

Pritchard

et al. 2019

J Parenter Enteral Nutr

117

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Background Malnutrition is a common complication in children with chronic diseases. Sarcopenia is one component of malnutrition, characterized by reduced skeletal muscle mass (SMM) and muscle function. The presence of sarcopenia is associated with adverse outcomes in children. Although there is growing research interest in sarcopenia, no review has been done on this novel concept in pediatrics. The purpose of this review was to explore current evidence in sarcopenia with and without obesity and to evaluate the knowledge gaps in the assessment of childhood sarcopenia. Methods A total of 12 articles retrieved from PubMed or Web of Science databases were included. Results Limited studies have elucidated sarcopenia in pediatrics. Challenges in sarcopenia assessment include heterogeneity in definition and absence of standardized body composition methods used to measure SMM and muscle function tests. There is a lack of age‐specific and gender‐specific normative data for SMM, particularly in young children and infants. None of the studies incorporated muscle function assessment, causing potential bias and misclassification of sarcopenia. The research in childhood sarcopenia is also hampered by low study quality, limited number of outcomes‐based research, and lack of longitudinal data. Conclusion Consensus needs to be reached in methodological approaches in sarcopenia diagnosis, body composition measurements, and age‐appropriate muscle function tests in pediatrics. Careful considerations on growth, neurocognitive status, and factors influencing development in various clinical populations are warranted. Early identification of sarcopenia is crucial to enable targeted treatment and prevention to be carried out across the pediatric clinical populations.

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Section: Discussionmentioning

confidence: 93%

Section: Body Composition Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Sarcopenia: A Paradigm in the Overall Definition of Malnutrition in Children?

Ooi

Thompson‐Hodgetts

Pritchard

et al. 2019

J Parenter Enteral Nutr

117

View full text Add to dashboard Cite

show abstract

“…However, others have used L4 as a landmark . Furthermore, other studies have cited SMM area as a more complete measure than PMA alone because it is closely related to total body protein and wait‐list mortality . PMT as an alternative indicator to assess for sarcopenia has also been proposed, but it requires further validation .…”

Section: Discussionmentioning

confidence: 99%

“…Use of cross‐sectional CT/MRI, segmental DEXA using appendicular measures, and phase angle BIA have been shown to be less influenced by overhydration than whole body measures . Although ascites may be a confounding factor in determinations of SMM, recent studies indicate that total body fluid status rather than the presence of ascites may be the determining factor . Although DEXA and BIA have been reported to overestimate muscle mass due to the assumption of constant tissue hydration, use of these methods may be clinically warranted to assess for sarcopenia when CT/MRI are unavailable .…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

et al. 2019

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Malnutrition is a common complication in patients with end‐stage liver disease (ESLD) awaiting liver transplantation (LT). Malnutrition and sarcopenia overlap in etiology and outcomes, with sarcopenia being defined as reduced skeletal muscle mass and muscle function. The purpose of this review was to identify the prevalence of sarcopenia with and without obesity in adults and children with ESLD and to assess the methodological considerations in sarcopenia diagnosis and the association of sarcopenia with pre‐ and post‐LT outcomes. A total of 38 articles (35 adult and 3 pediatric articles) retrieved from PubMed or Web of Science databases were included. In adults, the prevalence rates of pre‐LT sarcopenia, pre‐LT sarcopenic obesity (SO), post‐LT sarcopenia, and post‐LT SO were 14%‐78%, 2%‐42%, 30%‐100%, and 88%, respectively. Only 2 adult studies assessed muscle function in patients diagnosed with sarcopenia. The presence of pre‐LT sarcopenia is associated with higher wait‐list mortality, greater postoperative mortality, higher infection risk and postoperative complications, longer intensive care unit (ICU) stay, and ventilator dependency. The emerging pediatric data suggest that sarcopenia is prevalent in pre‐ and post‐LT periods. In 1 pediatric study, sarcopenia was associated with poor growth, longer perioperative length of stay (total/ICU) and ventilator dependency, and increased rehospitalization in children after LT. In conclusion, there is a high prevalence of sarcopenia in adults and children with ESLD. Sarcopenia is associated with adverse clinical outcomes. The present review is limited by heterogeneity in the definition of sarcopenia and in the methodological approaches in assessing sarcopenia. Future studies are needed to standardize the sarcopenia diagnosis and muscle function assessment, particularly in the pediatric population, to enable early identification and treatment of sarcopenia in adults and children with ESLD.

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Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

et al. 2021

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This is the first American Association for the Study of Liver Diseases (AASLD) Practice Guidance on the management of malnutrition, frailty, and sarcopenia in patients with cirrhosis. This guidance represents the consensus of a panel of experts after a thorough review and vigorous debate of the literature published to date, incorporating clinical experience and common sense to fill in the gaps when appropriate. Our goal was to offer clinicians pragmatic recommendations that could be implemented immediately in clinical practice to target malnutrition, frailty, and sarcopenia in this population. This AASLD Guidance document differs from AASLD Guidelines, which are supported by systematic reviews of the literature, formal rating of the quality of the evidence and strength of the recommendations, and, if appropriate, meta-analysis of results using the Grading of Recommendations Assessment Development and Evaluation system. In contrast, this Guidance was developed by consensus of an expert panel and provides guidance statements based on formal review and analysis of the literature on the topics, with oversight Accepted ArticleThis article is protected by copyright. All rights reserved provided by the AASLD Practice Guidelines Committee at all stages of Guidance development. The AASLD Practice Guidelines Committee chose to perform a Guidance on this topic because a sufficient number of randomized controlled trials (RCTs) were not available to support the development of a Guideline. Definitions of Malnutrition, Frailty, and Sarcopenia and Their Relationship in Patients With CirrhosisCirrhosis is a major predisposing condition for the development of malnutrition, frailty, and sarcopenia.Multiple, yet complementary, definitions of these conditions exist in the published domain outside of the field of hepatology, but consensus definitions have not yet been established by the AASLD for patients with cirrhosis. Furthermore, there has been ambiguity related to operationalization of these constructs in clinical practice. To address this, we offer definitions of the theoretical constructs of malnutrition, frailty, and sarcopenia as commonly represented in all populations, partnered with operational definitions, developed by consensus, to facilitate pragmatic implementation of these constructs in clinical practice as applied to patients with cirrhosis (Table 1). Malnutrition is a clinical syndrome that results from "an imbalance (deficiency or excess) of nutrients that causes measurable adverse effects on tissue/body form (body shape, size, composition) or function, and/or clinical outcome." 1 Key to this definition is the recognition that malnutrition represents a spectrum of nutritional disorders across the entire range of body mass index (BMI)from underweight to obese. By this definition, malnutrition leads to adverse physical effects, which, in patients with cirrhosis, are commonly manifested phenotypically as frailty or sarcopenia. Frailty has most commonly been defined as a clinical state of decreased physiologic reserve...

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Relationship Between Total Body Protein and Cross‐Sectional Skeletal Muscle Area in Liver Cirrhosis Is Influenced by Overhydration

Abstract: SMA is more closely related to TBP than is PMA, and should be preferred as a measure of sarcopenia. Overhydration significantly affects the measurement of cross-sectional muscle area. This article is protected by copyright. All rights reserved.

Cited by 22 publications

References 51 publications

Pediatric Sarcopenia: A Paradigm in the Overall Definition of Malnutrition in Children?

Pediatric Sarcopenia: A Paradigm in the Overall Definition of Malnutrition in Children?

Sarcopenia in Chronic Liver Disease: Impact on Outcomes

Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases

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