Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis

Abstract

Background and aimsObesity is frequently associated with cirrhosis, and cirrhotic patients may develop simultaneous loss of skeletal muscle and gain of adipose tissue, culminating in the condition of sarcopenic obesity. Additionally, muscle depletion is characterized by both a reduction in muscle size and increased proportion of muscular fat, termed myosteatosis. In this study, we aimed to establish the frequency and clinical significance of sarcopenia, sarcopenic obesity and myosteatosis in cirrhotic patients.MethodsWe analysed 678 patients with cirrhosis. Sarcopenia, sarcopenic obesity and myosteatosis were analysed by CT scan using the third lumbar vertebrae skeletal muscle and attenuation indexes, using previously validated gender‐and body mass index‐specific cutoffs.ResultsPatients were predominately men (n = 457, 67%), and cirrhosis aetiology was hepatitis C virus in 269 patients (40%), alcohol in 153 (23%), non‐alcoholic steatohepatitis/cryptogenic in 96 (14%), autoimmune liver disease in 55 (8%), hepatitis B virus in 43 (6%), and others in 5 patients (1%). Sarcopenia was present in 292 (43%), 135 had sarcopenic obesity (20%) and 353 had myosteatosis (52%). Patients with sarcopenia (22 ± 3 vs. 95 ± 22 months, P < 0.001), sarcopenic obesity (22 ± 3 vs. 95 ± 22 months, P < 0.001), and myosteatosis (28 ± 5 vs. 95 ± 22 months, P < 0.001) had worse median survival than patients without muscular abnormalities. By multivariate Cox regression analysis, both sarcopenia [hazard ratio (HR) 2.00, 95% confidence interval (CI) 1.44–2.77, P < 0.001], and myosteatosis (HR 1.42, 95% CI 1.02–1.07, P = 0.04) were associated with mortality.ConclusionsSarcopenia, sarcopenic obesity and myosteatosis are often present in patients with cirrhosis, and sarcopenia and myosteatosis are independently associated with a higher long‐term mortality in cirrhosis.

Myosteatosis to predict inferior perioperative outcome in patients undergoing orthotopic liver transplantation

“…[8][9][10][11][12][13] While some of these models are helpful in predicting posttransplant outcomes, none of these scores include information on the recipient's BC. While some studies have recently reported an association of sarcopenia with clinical outcome in cirrhosis and orthotopic liver transplantation (OLT), 15,[19][20][21][22][23] the prognostic value of muscle quality (skeletal muscle density and myosteatosis) compared to muscle quantity (skeletal muscle mass-SMM, as the morphological aspect of sarcopenia) remains to be determined. 2,15 The importance of nutritional status and its assessment in patients with chronic liver disease are further highlighted by the recent European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD) guidelines on nutrition in chronic liver disease.…”

Sarcopenic Obesity: Time to Meet the Challenge

“…Indeed low or declining muscle mass is emerging as a negative prognostic factor associated with higher morbidity and mortality in obese patients with chronic diseases [67,68]. Obese individuals with gastrointestinal cancers and low muscle mass accordingly had higher risk of dying than matched obese patients without muscle abnormalities [68]. In obese heart failure patients, low physical capacity also predicted poor outcome [62].…”

“…This could appear as contradictory to the so-called ‘obesity paradox', but it means that obesity does not protect from chronic disease-related mortality when it is associated with sarcopenia. Indeed low or declining muscle mass is emerging as a negative prognostic factor associated with higher morbidity and mortality in obese patients with chronic diseases [67,68]. Obese individuals with gastrointestinal cancers and low muscle mass accordingly had higher risk of dying than matched obese patients without muscle abnormalities [68].…”

Liver Transplantation in the Obese Cirrhotic Patient

“…7 Sarcopenic obesity, severe muscle depletion in the setting of obesity, is reported in 30% to 42% of obese patients with cirrhosis 8–10 and is associated with increased risk of pre-LT mortality. 9,11,12 Unfortunately, studies evaluating waitlist and post-LT outcomes do not use unified criteria for defining obesity or sarcopenia in this unique population, which may lead to discrepant results. Given the many limitations of BMI as a measure of obesity-related risk in liver transplant candidates, we recommend against its use as the sole measure of obesity in this population.…”