Impact of sarcopenia on survival in patients undergoing living donor liver transplantation.
TL;DR: Perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia and multivariate analysis showed that low skeletal muscle mass was an independent risk factor for death after transplantation.
About: This article is published in American Journal of Transplantation.The article was published on 2013-06-01 and is currently open access. It has received 310 citations till now. The article focuses on the topics: Sarcopenia & Transplantation.
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TL;DR: Using proteins with low ammoniagenic potential, leucine enriched amino acid supplementation, long-term ammonia lowering strategies and a combination of resistance and endurance exercise to increase muscle mass and function may target the molecular abnormalities in the muscle.
408 citations
Cites background from "Impact of sarcopenia on survival in..."
...Kaido (2013)[48] 124 Post living donor transplant lower with sarcopenia...
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TL;DR: The assessment criteria for sarcopenia in liver disease proposed by the Japan Society of Hepatology (JSH) are summarized in this article, where the authors present the assessment criteria to the best of their knowledge.
377 citations
TL;DR: This study aimed to establish the frequency and clinical significance of sarcopenia, sarcopenic obesity and myosteatosis in cirrhotic patients.
Abstract: Background and aims
Obesity 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
351 citations
Additional excerpts
...5) 51 (38) 131 (37) AILD 15 (7) 23 (8) 8 (6) 30 (9) HBV 18 (9) 18 (6) 8 (6) 14 (4) NASH-Cryptogenic 44 (21) 59 (20) 26 (19) 88 (25) Others 1 (0....
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TL;DR: Data from healthy young Asian adults were used to establish new criteria for low skeletal muscle mass that would be applicable for defining sarcopenia in Asian populations.
330 citations
TL;DR: Sarcopenia is significantly associated with mortality in patients with liver cirrhosis and branched-chain amino acid supplementation might be associated with improved survival of such patients.
286 citations
Cites background from "Impact of sarcopenia on survival in..."
...As a nutritional intervention for sarcopenia, the effect of perioperative nutritional therapy on sarcopenia in patients undergoing living-donor liver transplantation (LDLT) has been reported [22]....
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References
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TL;DR: To establish the prevalence of sarc Openia in older Americans and to test the hypothesis that sarcopenia is related to functional impairment and physical disability in older persons is established.
Abstract: OBJECTIVES: To establish the prevalence of sarcopenia in older Americans and to test the hypothesis that sarcope- nia is related to functional impairment and physical dis- ability in older persons. DESIGN: Cross-sectional survey. SETTING: Nationally representative cross-sectional sur- vey using data from the Third National Health and Nutri- tion Examination Survey (NHANES III). PARTICIPANTS: Fourteen thousand eight hundred eigh- teen adult NHANES III participants aged 18 and older. MEASUREMENTS: The presence of sarcopenia and the relationship between sarcopenia and functional impairment and disability were examined in 4,504 adults aged 60 and older. Skeletal muscle mass was estimated from bioimped- ance analysis measurements and expressed as skeletal mus- cle mass index (SMIskeletal muscle mass/body mass � 100). Subjects were considered to have a normal SMI if their SMI was greater than -one standard deviation above the sex-specific mean for young adults (aged 18-39). Class I sarcopenia was considered present in subjects whose SMI was within -one to -two standard deviations of young adult values, and class II sarcopenia was present in subjects whose SMI was below -two standard deviations of young adult values. RESULTS: The prevalence of class I and class II sarcope- nia increased from the third to sixth decades but remained relatively constant thereafter. The prevalence of class I (59% vs 45%) and class II (10% vs 7%) sarcopenia was greater in the older ( � 60 years) women than in the older men ( P � .001). The likelihood of functional impairment and disability was approximately two times greater in the older men and three times greater in the older women with class II sarcopenia than in the older men and women with a normal SMI, respectively. Some of the associations be- tween class II sarcopenia and functional impairment re- mained significant after adjustment for age, race, body mass index, health behaviors, and comorbidity. CONCLUSIONS: Reduced relative skeletal muscle mass in older Americans is a common occurrence that is signifi- cantly and independently associated with functional im- pairment and disability, particularly in older women. These observations provide strong support for the prevailing view that sarcopenia may be an important and potentially re- versible cause of morbidity and mortality in older persons. J Am Geriatr Soc 50:889-896, 2002.
2,710 citations
"Impact of sarcopenia on survival in..." refers background or methods in this paper
...(36) also used SD to define sarcopenia, measured in terms of the skeletal muscle index, which is the skeletal muscle mass/body mass 100....
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...defined class I and class II sarcopenia to be present in subjects whose skeletal muscle index was within 1 to 2 SD and below 2 SD of young adult values, respectively (36)....
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...There have been a few reports discussing the diagnosis of sarcopenia (35,36), while indicating no consensus on the definition of sarcopenia....
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TL;DR: On-going and future clinical trials on sarcopenia may radically change the authors' preventive and therapeutic approaches of mobility disability in older people.
Abstract: Sarcopenia is a loss of muscle protein mass and loss of muscle function. It occurs with increasing age, being a major component in the development of frailty. Current knowledge on its assessment, etiology, pathogenesis, consequences and future perspectives are reported in the present review. On-going and future clinical trials on sarcopenia may radically change our preventive and therapeutic approaches of mobility disability in older people.
886 citations
"Impact of sarcopenia on survival in..." refers background in this paper
...Sarcopenia, defined as a low level of muscle mass, is associated with an increased risk for age-related decline in muscular strength and functional ability (16,17)....
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TL;DR: Two methods for classifying an individual as sarcopenic for predicting decline in physical function in the Health, Aging and Body Composition Study are compared.
Abstract: OBJECTIVES: To compare two methods for classifying an individual as sarcopenic for predicting decline in physical function in the Health, Aging and Body Composition Study.
DESIGN: Observational cohort study with 5 years of follow-up.
SETTING: Communities in Memphis, Tennessee, and Pittsburgh, Pennsylvania.
PARTICIPANTS: Men and women aged 70 to 79 (N=2,976, 52% women, 41% black).
MEASUREMENTS: 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.
RESULTS: 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/ht2 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/ht2 method had lower 5-year decline. Additional adjustment for fat mass attenuated this protective effect.
CONCLUSION: 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/ht2 method, because it considers fat as part of the definition.
669 citations
"Impact of sarcopenia on survival in..." refers result in this paper
...In contrast, other investigators measured the psoas muscle area or the muscle cross sectional area at the L3 vertebral level using available CT and MRI images (23,31) or calculated skeletal muscle mass using dual energy X-ray absorptiometry (34)....
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TL;DR: Central sarcopenia strongly correlates with mortality after liver transplantation and the impact of psoas area on survival exceeded that of all other covariates in these models.
Abstract: Background Surgeons frequently struggle to determine patient suitability for liver transplantation. Objective and comprehensive measures of overall burden of disease, such as sarcopenia, could inform clinicians and help avoid futile transplantations. Study Design The cross-sectional area of the psoas muscle was measured on CT scans of 163 liver transplant recipients. After controlling for donor and recipient characteristics using Cox regression models, we described the relationship between psoas area and post-transplantation mortality. Results Psoas area correlated poorly with Model for End-Stage Liver Disease score and serum albumin. Cox regression revealed a strong association between psoas area and post-transplantation mortality (hazard ratio=3.7/1,000 mm 2 decrease in psoas area; p Conclusions Central sarcopenia strongly correlates with mortality after liver transplantation. Such objective measures of patient frailty, such as sarcopenia, can inform clinical decision making and, potentially, allocation policy. Additional work is needed develop valid and clinically relevant measures of sarcopenia and frailty in liver transplantation.
664 citations
"Impact of sarcopenia on survival in..." refers background or methods or result in this paper
...In deceased donor liver transplantation (DDLT), other investigators have reported that sarcopenia evaluated by psoas area as determined by CT or magnetic resonance imaging (MRI) was associated with increased waiting list mortality and posttransplant mortality (23,31)....
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...In contrast, other investigators measured the psoas muscle area or the muscle cross sectional area at the L3 vertebral level using available CT and MRI images (23,31) or calculated skeletal muscle mass using dual energy X-ray absorptiometry (34)....
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...(23) recently reported that central sarcopenia strongly correlated with postliver transplant mortality, using the size of the psoas muscle as measured by computed tomography (CT) scan....
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TL;DR: EN by means of ONS is recommended for patients with chronic LD in whom undernutrition is very common and TF commenced early after liver transplantation can reduce complication rate and cost and is preferable to parenteral nutrition.
620 citations