Review article: prognostic significance of body composition abnormalities in patients with cirrhosis

Ebadi, Maryam; Bhanji, Rahima A.; Tandon, Puneeta; Mazurak, Vera C.; Baracos, Vickie E.; Montano‐Loza, Aldo J.

doi:10.1111/apt.15927

Cited by 46 publications

(61 citation statements)

References 124 publications

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“…The association between subcutaneous fat and mortality has also been observed in regard to other conditions, such as cancer [114] and cirrhosis [115]. In a study conducted by Ebadi et al, the association between subcutaneous fat and mortality in 1473 gastrointestinal and respiratory cancer and 273 metastatic renal cell carcinoma patients was investigated using CT results.…”

Section: Subcutaneous Fat and Mortalitymentioning

confidence: 99%

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Okuno

2021

Nutrients

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In the general population, obesity is known to be associated with adverse outcomes, including mortality. In contrast, high body mass index (BMI) may provide a survival advantage for hemodialysis patients, which is known as the obesity paradox. Although BMI is the most commonly used measure for the assessment of obesity, it does not distinguish between fat and lean mass. Fat mass is considered to serve as an energy reserve against a catabolic condition, while the capacity to survive starvation is also thought to be dependent on its amount. Thus, fat mass is used as a nutritional marker. For example, improvement of nutritional status by nutritional intervention or initiation of hemodialysis is associated with an increase in fat mass. Several studies have shown that higher levels of fat mass were associated with better survival in hemodialysis patients. Based on body distribution, fat mass is classified into subcutaneous and visceral fat. Visceral fat is metabolically more active and associated with metabolic abnormalities and inflammation, and it is thus considered to be a risk factor for cardiovascular disease and mortality. On the other hand, subcutaneous fat has not been consistently linked to adverse phenomena and may reflect nutritional status as a type of energy storage. Visceral and subcutaneous adipose tissues have different metabolic and inflammatory characteristics and may have opposing influences on various outcomes, including mortality. Results showing an association between increased subcutaneous fat and better survival, along with other conditions, such as cancer or cirrhosis, in hemodialysis patients have been reported. This evidence suggests that fat mass distribution (i.e., visceral fat and subcutaneous fat) plays a more important role for these beneficial effects in hemodialysis patients.

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Section: Subcutaneous Fat and Mortalitymentioning

confidence: 99%

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Okuno

2021

Nutrients

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“… 87 Low SMI correlates with poorer outcomes in several studies in patients with liver disease. 88 However, although CT scans are frequently performed in cirrhosis, this cannot be considered a point-of-care test for sarcopenia. Therefore, other reliable and easily available tools, aiming to evaluate performance status, and which indirectly estimate sarcopenia, have been developed.…”

Section: Pre- and Postoperative Evaluation And Management Of Patients With Chronic Liver Disease And Cirrhosismentioning

confidence: 99%

Risks and Rewards of Bariatric Surgery in Advanced Chronic Liver Diseases

et al. 2021

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The burden of obesity and metabolic syndrome has determined a sharp increase in bariatric surgery (BS) procedures, which lead to marked weight loss, improved metabolic syndrome, reduced cardiovascular risk, and even improvement in nonalcoholic steatohepatitis (NASH). Despite these promising results, BS in patients with chronic liver disease can rarely lead to worsening of liver function, progression to cirrhosis and its complications, and even liver transplantation. On the other hand, since obesity in patients with cirrhosis is a major cofactor for progression to a decompensated stage of the disease and a risk factor for hepatocellular carcinoma, BS has been used to achieve weight loss in this population. In this review, we critically analyze the existing data on outcomes of BS in patients with cirrhosis and the possible mechanisms leading to fibrosis progression and worsening liver function in patients undergoing BS. Finally, we propose a set of measures that could be taken to improve the multidisciplinary management of liver disease in patients undergoing BS, including early recognition of malnutrition and alcohol misuse.

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“…Evaluation of body composition, including muscle and adipose tissue, gives rise to an objective assessment of the patients' metabolic and nutritional status. Muscles are responsible for mechanical activity, whereas adipose tissue is involved in energy regulation and metabolic action ( 6 ). We and others have substantially clarified the prognostic utility of several abnormalities in body composition features for outcomes in patients with cirrhosis ( 7 – 9 ).…”

Section: Introductionmentioning

confidence: 99%

Visceral Adiposity Associates With Malnutrition Risk Determined by Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

Wang

Sun

et al. 2021

Front. Nutr.

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Mounting evidence has suggested the clinical significance of body composition abnormalities in the context of cirrhosis. Herein, we aimed to investigate the association between visceral adiposity and malnutrition risk in 176 hospitalized patients with cirrhosis. The adiposity parameters were obtained by computed tomography (CT) as follows: total adipose tissue index (TATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral to subcutaneous adipose tissue area ratio (VSR). Malnutrition risk was screened using Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Visceral adiposity was determined given a higher VSR based on our previously established cutoffs. Multivariate analysis implicated that male gender (OR = 2.884, 95% CI: 1.360–6.115, p = 0.006), BMI (OR = 0.879, 95% CI: 0.812–0.951, P = 0.001), albumin (OR = 0.934, 95% CI: 0.882–0.989, P = 0.019), and visceral adiposity (OR = 3.413, 95% CI: 1.344–8.670, P = 0.010) were independent risk factors of malnutrition risk. No significant difference was observed regarding TATI, SATI, and VATI among patients with low or moderate and high risk of malnutrition. In contrast, the proportion of male patients embracing visceral adiposity was higher in high malnutrition risk group compared with that in low or moderate group (47.27 vs. 17.86%, p = 0.009). Moreover, this disparity was of borderline statistical significance in women (19.05 vs. 5.88%, p = 0.061). Assessing adipose tissue distribution might potentiate the estimation of malnutrition risk in cirrhotics. It is pivotal to recognize visceral adiposity and develop targeted therapeutic strategies.

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Review article: prognostic significance of body composition abnormalities in patients with cirrhosis

Cited by 46 publications

References 124 publications

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis

Risks and Rewards of Bariatric Surgery in Advanced Chronic Liver Diseases

Visceral Adiposity Associates With Malnutrition Risk Determined by Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

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