Sarcopenia as a Prognostic Index of Nutritional Status in Concurrent Cirrhosis and Hepatocellular Carcinoma

Abstract

Sarcopenia is present in almost one third of patients with HCC, and constitutes a strong and independent risk factor for mortality. Our results highlight the importance of body composition assessment in clinical practice.

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

“…Sarcopenia and myosteatosis have been significantly associated with a range of adverse outcomes including increased rate of post‐operative complications,10, 11, 40, 41, 42 longer length of hospital stay,41, 43 30‐day post‐operative mortality and in‐hospital mortality,44 and dose‐limiting toxicities 5, 6, 7, 8, 45, 46, 47, 48, 49, 50. In addition, the conditions have been demonstrated as independent predictors of reduced overall survival 18, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64. The situation is further complicated by the obesity epidemic that has been progressively worsening in recent times.…”

Systematic Review and Meta-Analysis of the Impact of Computed Tomography–Assessed Skeletal Muscle Mass on Outcome in Patients Awaiting or Undergoing Liver Transplantation

“…The methods of muscle measurement and sarcopenia definitions that were used are summarized in Table 2. Nine studies reported the cross-sectional muscle area with corresponding skeletal muscle index (12)(13)(14)17,(22)(23)(24)(25)30), whereas the psoas area was reported in eight studies (15,16,18,19,21,(26)(27)(28) and the dorsal muscle group area was reported in one study (20). One study calculated the morphometric age (calculated with total psoas area, psoas density, and abdominal aortic calcifications) (29).…”

“…From these 28 records, eight studies assessed muscle mass with means other than CT and one study was performed in a population other than patients awaiting or undergoing liver transplantation. The remaining 19 studies, including 3803 patients in partly overlapping cohorts, were included in this systematic review (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Cross-referencing yielded no additional records.…”

“…The median MELD score ranged from 9 to 21, the median albumin level from 2.8 to 3.4 g/dL, and median BMI from 24.0 to 29.4 kg/m². Eight studies included cirrhosis patients only (12,15,17,(22)(23)(24)27,28), of which one study included only Child-Pugh A patients (28).…”

Proposal for new selection criteria considering pre‐transplant muscularity and visceral adiposity in living donor liver transplantation

“…Among various imaging modalities, such as dual‐energy X‐ray absorptiometry, computed tomography (CT), magnetic resonance imaging, and bioimpedance analysis, CT seems the best suited to measuring skeletal muscle mass in clinical settings, particularly in the surgical field, as CT is usually performed as part of the pre‐operative work‐up and during follow‐up. Although several studies from Western countries have proposed different cut‐offs for low skeletal muscle mass as calculated from CT,2, 3, 5 such values would differ from those in Asian populations, due to general differences in characteristics such as body size, lifestyles, and other factors. We have previously established new diagnostic criteria for low skeletal muscle mass by using the psoas muscle mass index from healthy young Asian adults, which was adopted in the Japan Society of Hepatology guidelines for sarcopenia in liver disease 13, 14.…”