Sarcopenia and Frailty in Chronic Liver Damage: Common and Different Points

Abstract

Aim: To elucidate the common and different points between sarcopenia and frailty in chronic liver damage (CLD). Patients and Methods: Patients with both grip strength decline and skeletal muscle index decline were regarded as sarcopenia. Frailty was defined as a syndrome in which 3 or more of the following criteria were met: i) exhaustion, ii) body weight loss, iii) slow walking speed, iv) muscle weakness, and v) low physical activity. Results: Sarcopenia and frailty were identified in 52 patients (15.2%) and 46 (13.5%), respectively. The prevalence of sarcopenia and frailty was well stratified according to age and the liver cirrhosis (LC) status. In the multivariate analysis, we identified significant factors for sarcopenia: i) age, ii) LC, iii) body mass index and iv) extracellular water (ECW) to total body water (TBW) ratio, while only the ECW to TBW ratio was significant for frailty. Conclusion: Sarcopenia and frailty in CLD should be separately evaluated. In individuals with chronic liver damage (CLD), metabolic functions are frequently damaged leading to several nutritional disorders, including protein-energy-malnutrition, or muscle abnormalities (1). Since sarcopenia, as assessed by muscle mass decrease and muscle strength impairment in patients with CLD, can be related to falls, poor quality of life or poor prognosis, it has become a very interesting topic to examine for physicians (2-8). Sarcopenia is one of the most common consequences found in patients with liver cirrhosis (LC), affecting 30% to 70% of LC patients, and it can be a main determinant for the incidence of hepatic encephalopathy in LC patients (1, 9, 10-13). Japanese CLD patients can now be found in aging populations, and this fact is also a crucial public health issue since aging itself can cause sarcopenia (14-16). To avoid unfavorable consequences related to sarcopenia one needs to assess this disease as a condition with a systemic involvement (17-19). Improving physical activity or nutrition and adequately managing any underlying diseases are essential steps for avoiding sarcopenia (6). Frailty is a concept globally used in geriatrics that precedes disability, and is defined as a condition of increased vulnerability associated with physiological decline (20-22). Originally, it was proposed to identify elderly people at an elevated risk of adverse health outcomes, dependencies, falls, disabilities, and mortality (20-22). Frailty is determined based on the evaluation of physical, functional and cognitive abilities. The frailty phenotype is defined as the presence of 3 or more of the following criteria: i) body weight (BW) loss, ii) self-reported exhaustion, iii) skeletal muscle function decline, iv) slow walking speed (WS) and v) low physical activity (23, 24). Sarcopenia is an important component of frailty (22). Aging is indeed closely linked to changes in body composition, especially skeletal muscle mass decline, resulting in disability and mortality (14, 16, 24). While any chronic organ dysfunction can also lead to physiological vulne...

Sarcopenia may Influence the Prognosis in Advanced Thyroid Cancer Patients Treated With Molecular Targeted Therapy

“…As patients with advanced thyroid cancer can use fewer molecular targeted agents, it is crucial to determine the best time for drug introduction, ensuring both safety and effectiveness. Furthermore, in various digestive disorders including cancers, sarcopenia is reportedly associated with postoperative mortality, recurrence, and the development of adverse effects and complications (23,24). Based on these reports, we investigated how sarcopenia, as well as the nutritional status before the initiation of molecular targeted therapy, may influence the prognosis and toxicity of molecularly targeted agents in patients with advanced thyroid cancer.…”

Sarcopenia and Frailty in Liver Cirrhosis

“…Pre-frail is a reversible condition similarly to frailty, and the significance of early intervention in the pre-frail stage needs to be examined [ 75 ]. On the other hand, the frequency of frailty was not affected by body mass index (BMI) in our data [ 74 ]. Similar results were reported by Lai, et al [ 76 ].…”

“…The prevalence of frailty among community-dwelling elderly persons was 5.6% in Japan [ 73 ]. In our study of CLD patients using Fried criteria ( n = 341, 122 LC cases, median age = 66 years), 46 (13.5%) were frailty and 187 (54.8%) were pre-frail, with the frequency of frailty increasing with age ( p = 0.0002), and the proportion of LC patients in frailty patients was higher than that in non-frailty patients (67.4% (31/46) vs. 30.9% (91/295), p < 0.0001) [ 74 ]. These results mean that frailty, like sarcopenia, has aspects that are caused by the disease condition.…”

“…Similar results were reported by Lai, et al [ 76 ]. In our study, we found that the frequency of sarcopenia increased with decreasing BMI; in other words, lower BMI can be a risk factor for sarcopenia, and the discrepancy between the two is interesting ( Table 2 ) [ 74 ]. Although sarcopenia is the main component of physical frailty, the differences between the two should also be recognized.…”

Sarcopenia, frailty and type 2 diabetes mellitus (Review)

“…In addition, it is reported that IL-6 secreted by skeletal muscle stimulates the secretion of glucagon like peptide-1 (GLP-1) during exercise, and exercise is also associated with changes in insulin and glucagon secretion (31,32). Liver cirrhosis (LC), which is considered to be a typical form of secondary sarcopenia because of its tendency to cause protein-energy malnutrition, is also associated with a high rate of IR (20,23,(33)(34)(35). LC patients are characterized by postprandial hyperglycemia (33).…”