Tongue thickness in health vs cirrhosis of the liver: Prospective observational study

Abstract

BACKGROUND Malnutrition affects 40%-90% of patients with cirrhosis of the liver. L3 skeletal muscle index (L3SMI) is presently accepted as the most objective and quantitative measure available for sarcopenia, a surrogate marker of malnutrition. L3SMI application is, however, limited by non-availability of computed tomography scanning in remote areas, cost, need for extensive training, and the risk of exposure to radiation. Therefore, an alternative dependable measure with wider availability is needed. Malnutrition causes sarcopenia not only in skeletal muscles but also in other muscular structures such as the psoas muscle, diaphragm and tongue. We therefore hypothesised that the tongue, being easily accessible for inspection and for measurement of thickness using ultrasonography, may be used to document sarcopenia. AIM To measure and compare tongue thickness in healthy individuals and in patients with cirrhosis of the liver and to study its correlation with conventional prognostic scores for patients with cirrhosis of the liver. METHODS Tongue thickness was measured using ultrasonography. One hundred twenty subjects of either gender aged 18 to 65 years were studied, with 30 subjects in each group. The tongue thickness was compared between groups based on “Child Turcotte Pugh” (CTP) scores. The correlations between measured tongue thickness and “Model for end stage liver disease” (MELD) score and between age and measured tongue thickness were also assessed. RESULTS Mean tongue thickness (mean ± SD) in patients with CTP class A, B and C was 4.39 ± 0.39 cm, 4.19 ± 0.53 cm, and 3.87 ± 0.42, respectively, and was 4.33 ± 0.49 cm in normal healthy individuals. Significant differences were seen in tongue thickness between patients with CTP class C and those with CTP class A and B ( P < 0.05). Patients with CTP class C also had a significantly reduced tongue thickness than normal individuals ( P < 0.05). However, no significant difference was seen in tongue thickness between patients with CTP class A and B and normal individuals. A statistically significant, negative correlation was found between MELD score and tongue thickness ( r = -0.331) ( P < 0.001). No correlation was observed between L3SMI and MELD score ( r = 0.074, P = 0.424). L3SMI (mean ± SD) in healthy subjects was 39.66 ± 6.8 and was 38.26 ± 8.88 in patients with CTP class C, and the difference was not significant. No significant correlation was found between age of the patients and tongue thickness. Intra-class correlation coefficient was used to determine the reliability of the tongue thickness measurements. The intra-class correlation coefficient was 0.984 (95%CI: 0.979-0.989) and was indicative of good reliability. CONCLUSION Tongue thickness measured by ultrasonogr...

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

“…Methods to assess muscle mass in patients with cirrhosis are detailed in Table 3. [171][172][173][174][175][176][177][178] CT imaging is currently the gold standard for assessment of muscle mass in cirrhosis, but cost and exposure to ionizing radiation make routine use of CT solely for the purpose of detecting sarcopenia impractical in many clinical settings. (129) However, when abdominal CT imaging is performed for clinical reasons-such as in patients with HCC or for surgical planning (e.g., transplant, hepatectomy)-muscle mass measurement can be obtained from clinical scans using readily available quantitative morphomics software.…”

Relationship chains of subhealth physical examination indicators: a cross-sectional study using the PLS-SEM approach

“…To explain the path from liver function to characteristics of SV, the concept of "liver tongue" has long appeared in TCM, and it is considered to be a specific manifestation of liver cirrhosis 41 . A study recommended that the measurement of tongue thickness should be considered for diagnosing sarcopenia in cirrhosis of the liver 42 . Another study found that patients with liver cirrhosis are more likely to develop sublingual varices 43 , specifically swelling and extreme fullness of the SV.…”

“…SV sublingual veins, SV-L the value of the sublingual veins on the L-axis in Lab colour space, SV-a the value of the sublingual veins on the a-axis in Lab colour space, SV-b the value of the sublingual veins on the b-axis in Lab colour space, T1 grade 1 of sublingual veins tortuosity, T2 grade 2 of sublingual veins tortuosity, T3 grade 3 of sublingual veins tortuosity, L1 grade 1 of sublingual veins trunk-length, L2 grade 2 of sublingual veins trunk-length, L3 grade 3 of sublingual veins trunk-length, W1 grade 1 of sublingual veins width, W2 grade 2 of sublingual veins width, W3 grade 3 of sublingual veins width. www.nature.com/scientificreports/ measurement of tongue thickness should be considered for diagnosing sarcopenia in cirrhosis of the liver 42 .…”

Muscular abnormalities in liver cirrhosis

“…Measurements of the tongue muscle thickness in the group of patients with liver cirrhosis showed an association with the CHILD and MELD score, and a distinctive difference between the group of healthy control group, but with no proven CT control correlation. The definition of liver cirrhosis in the article was relatively loose[ 41 ].…”