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      Comparative assessment of sarcopenia using the JSH, AWGS, and EWGSOP2 criteria and the relationship between sarcopenia, osteoporosis, and osteosarcopenia in patients with liver cirrhosis

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          Abstract

          Background

          Sarcopenia and osteoporosis reduce life quality and worsen prognosis in patients with liver cirrhosis (LC). When these two complications coexist, a diagnosis of osteosarcopenia is made. We aimed to investigate the actual situations of sarcopenia, osteoporosis, osteosarcopenia, and vertebral fracture, and to clarify the relationship among these events in patients with LC.

          Methods

          We describe a cross-sectional study of 142 patients with LC. Sarcopenia was defined according to the Japan Society of Hepatology (JSH) criteria, Asian Working Group for Sarcopenia (AWGS) criteria, and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. The skeletal muscle mass index (SMI) and handgrip strength were assessed using bioelectrical impedance analysis and a digital grip strength dynamometer, respectively. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry, and vertebral fracture was evaluated using spinal lateral X-rays. The severity of LC was assessed using the Child-Pugh classification.

          Results

          Among the 142 patients, the prevalence of sarcopenia was 33.8% (48/142) according to the JSH and AWGS criteria and 28.2% (40/142) according to the EWGSOP2 criteria. The number of patients with osteoporosis, osteosarcopenia, and vertebral fracture was 49 (34.5%), 31 (21.8%), and 41 (28.9%), respectively. Multivariate analysis revealed a close association between sarcopenia and osteoporosis. Osteoporosis was independently associated with sarcopenia [odds ratio (OR) = 3.923, P = 0.010]. Conversely, sarcopenia was independently associated with osteoporosis (OR = 5.722, P < 0.001). Vertebral fracture occurred most frequently in patients with osteosarcopenia (19/31; 61.3%) and least frequently in those without both sarcopenia and osteoporosis (12/76; 15.8%). The SMI and handgrip strength values were significantly correlated with the BMD of the lumbar spine ( r = 0.55 and 0.51, respectively; P < 0.001 for both), femoral neck, ( r = 0.67 and 0.62, respectively; P < 0.001 for both), and total hip ( r = 0.67 and 0.61, respectively; P < 0.001 for both).

          Conclusions

          Sarcopenia , osteoporosis, osteosarcopenia, and vertebral fracture were highly prevalent and closely associated with one another in patients with LC. Specifically, patients with osteosarcopenia had the highest risk of vertebral fractures. Early diagnosis of these complications is essential for treatment intervention .

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          Most cited references26

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          Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women.

          To compare two methods for classifying an individual as sarcopenic for predicting decline in physical function in the Health, Aging and Body Composition Study. Observational cohort study with 5 years of follow-up. Communities in Memphis, Tennessee, and Pittsburgh, Pennsylvania. Men and women aged 70 to 79 (N=2,976, 52% women, 41% black). Appendicular lean mass (aLM) was measured using dual energy x-ray absorptiometry, and participants were classified as sarcopenic first using aLM divided by height squared and then using aLM adjusted for height and body fat mass (residuals). Incidence of persistent lower extremity limitation (PLL) was measured according to self-report, and change in objective lower extremity performance (LEP) measures were observed using the Short Physical Performance Battery. There was a greater risk of incident PLL in women who were sarcopenic using the residuals sarcopenia method than in women who were not sarcopenic (hazard ratio (HR)=1.34, 95% confidence interval (CI)=1.11-1.61) but not in men. Those defined as sarcopenic using the aLM/ht(2) method had lower incident PLL than nonsarcopenic men (HR=0.76, 95% CI=0.60-0.96) and women (HR=0.75, 95% CI=0.60-0.93), but these were no longer significant with adjustment for body fat mass. Using the residuals method, there were significantly poorer LEP scores in sarcopenic men and women at baseline and Year 6 and greater 5-year decline, whereas sarcopenic men defined using the aLM/ht(2) method had lower 5-year decline. Additional adjustment for fat mass attenuated this protective effect. These findings suggest that sarcopenia defined using the residuals method, a method that considers height and fat mass together, is better for predicting disability in an individual than the aLM/ht(2) method, because it considers fat as part of the definition.
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            Surgery and portal hypertension.

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              Sarcopenia impairs prognosis of patients with liver cirrhosis.

              Sarcopenia is characterized by the loss of skeletal muscle mass, and is reported to appear in patients with liver cirrhosis (LC). The aim of this study was to investigate the prevalence of sarcopenia in patients with LC, and to test the association between sarcopenia and patient outcomes. We also analyzed the effect of branched-chain amino acid (BCAA) supplementation on sarcopenic LC.
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                Author and article information

                Contributors
                chisato@jikei.ac.jp
                atsubo@jikei.ac.jp
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                26 December 2019
                26 December 2019
                2019
                : 20
                : 615
                Affiliations
                [1 ]ISNI 0000 0001 0661 2073, GRID grid.411898.d, Division of Gastroenterology and Hepatology, Department of Internal Medicine, , The Jikei University School of Medicine, ; 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461 Japan
                [2 ]Division of Gastroenterology, Department of Internal Medicine, Fuji City General Hospital, Shizuoka, Japan
                [3 ]ISNI 0000 0001 0661 2073, GRID grid.411898.d, Department of Rehabilitation Medicine, , The Jikei University School of Medicine, ; Tokyo, Japan
                [4 ]ISNI 0000 0001 0661 2073, GRID grid.411898.d, Department of Laboratory Medicine, , The Jikei University School of Medicine, ; Tokyo, Japan
                [5 ]ISNI 0000 0001 0661 2073, GRID grid.411898.d, Core Research Facilities, Research Center for Medical Science, , The Jikei University School of Medicine, ; Tokyo, Japan
                Author information
                http://orcid.org/0000-0002-7407-6142
                Article
                2983
                10.1186/s12891-019-2983-4
                6933666
                31878909
                851a4ccc-d04d-425f-839d-83326a8f8eac
                © The Author(s). 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 June 2019
                : 2 December 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Orthopedics
                liver cirrhosis,sarcopenia,sarcopenia assessment criteria,osteoporosis,osteosarcopenia,vertebral fracture

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