Cirrhosis serves as the final stage of various chronic liver damage,accounting for around one million deaths annually in the world.Given the clinical significance and the imperative to relieve this social as well as h...Cirrhosis serves as the final stage of various chronic liver damage,accounting for around one million deaths annually in the world.Given the clinical significance and the imperative to relieve this social as well as healthcare burden in relation to cirrhosis,a prompt and accurate evaluation of its prognostication is of the essence.In the recent years,the assessment of handgrip strength(HGS)concerning its prognostic utility among patients with cirrhosis has received intensive attention and increasing interest.Notably,the advantages to measure HGS are simple,convenient,noninvasive,cost-effective,and easy to be widely carried out during daily clinical practice.Mounting evidence demonstrates that muscle strength measured by HGS is a feasible and reliable metric to evaluate nutritional status,as well as relevant cirrhosis-related complications and mortality.Given the current lack of a landscape pertinent to prognostic performance of HGS in the context of cirrhosis,we conducted a narrative review on the predictive value of HGS in patients with cirrhosis.The validity and reliability of this metric for prognostication among cirrhosis have been comprehensively summarized,to improve the integral management and tailored therapy.展开更多
Skeletal muscle and fat tissue show distinct pathophysiological roles and pivotal functions.The culmination of muscle wasting and fat accumulation represents an opposite terminal of each state.Specifically,this situa...Skeletal muscle and fat tissue show distinct pathophysiological roles and pivotal functions.The culmination of muscle wasting and fat accumulation represents an opposite terminal of each state.Specifically,this situation has been designated as sarcopenic obesity.However,sarcopenic obesity still lacks a unanimous definition,diagnostic criteria,and generalized modalities for assessment in the context of versatile liver diseases.Moreover,the underpinning mechanisms by which a combination of abnormal skeletal muscle and fat tissue leads to the progression of liver disease and impairs health‐related consequences are still elusive.Additionally,the interplay between skeletal muscle and fat,and the driving factors that shift different body compositions are not well understood.Therefore,in this review,we discuss skeletal muscle and fat components,with the purpose of conceptualization,as well as interpret their roles in liver diseases.We focus on the definitions,diagnostic criteria,and currently available measurements for sarcopenic obesity in the literature.We comprehensively discuss recent data and evidence regarding the potential role of sarcopenic obesity in the development and progression of numerous liver diseases and associated conditions,including nonalcoholic fatty liver disease,chronic viral hepatitis,cirrhosis,and liver transplantation.Furthermore,explicit information related to the pathogenesis of sarcopenic obesity from basic research is also provided in this narrative review.Finally,we discuss,from the clinical perspective of view,how to manage sarcopenic obesity using nutritional,physical,and pharmacological methods.展开更多
Aim:Sarcopenia,multidimensional frailty,and malnutrition represent common debilitating conditions in the context of cirrhosis,linked to a variety of dismal outcomes.We aimed to clarify their overlap and cumulative imp...Aim:Sarcopenia,multidimensional frailty,and malnutrition represent common debilitating conditions in the context of cirrhosis,linked to a variety of dismal outcomes.We aimed to clarify their overlap and cumulative impact on long-term mortality in hospitalized patients with cirrhosis.Methods:Consecutive patients with cirrhosis were prospectively recruited from January 2018 to December 2020.The diagnosis of sarcopenia,multidimensional frailty,and malnutrition was standardized according to the consensus definition and our well-documented criteria.The prevalence of the respective debilitating condition and the concurrence of this comorbidity were calculated.Results:In total,253 patients with cirrhosis aged 64 years with a female predominance(52.4%)were recruited.Sarcopenia was present in 20.9%(53/253),multidimensional frailty in 12.6%(32/253),and malnutrition in 44.7%(113/253)of the entire cohort.Approximately half of the patients had at least one debilitating condition(127/253).Sarcopenia and malnutrition co-existed in 33 nonfrail patients(13.0%)and multidimensional frailty and malnutrition in eight nonsarcopenic patients(3.2%).Fifteen(5.9%)subjects had all three debilitating conditions,namely malnutrition,sarcopenia,and frailty(MSF)group.The proportions of males,infections,and ascites were significantly higher in the MSF group.Patients in the MSF group had the highest levels of neutrophil-to-lymphocyte ratio and creatinine.The 2-year mortality rates in patients with three debilitating conditions,two conditions,one condition,and no conditions were 60.0%,23.8%,21.4%,and 13.5%,respectively.Multivariate Cox regression indicated the long-term mortality risk was approximately four-fold higher among patients in the MSF group compared to those with no conditions.Conclusions:A fraction of patients with cirrhosis exhibited comorbidities of sarcopenia,multidimensional frailty,and malnutrition,linked to a higher risk of long-term mortality.展开更多
Background and Aims:Emerging evidence has demonstrated that abnormal body composition may potentiate the development of frailty,whereas little work focuses on the role of divergent adipose tissue.Therefore,we aimed to...Background and Aims:Emerging evidence has demonstrated that abnormal body composition may potentiate the development of frailty,whereas little work focuses on the role of divergent adipose tissue.Therefore,we aimed to determine the potential contribution of adipose tissue distribution to multidimensional frailty in decompensated cirrhosis.Methods:We conducted a retrospective cohort study.Divergent adipose tissues were assessed by computed tomography-derived subcutaneous adipose tissue index(SATI),visceral adipose tissue index(VATI)and total adipose tissue index(TATI),respectively.Frailty was identified by our validated self-reported Frailty Index.Multiple binary logistic models incorporating different covariates were established to assess the relationship between adipose tissue distribution and frailty.Results:The study cohort comprised 245 cirrhotic patients with 45.3%being male.The median Frailty Index,body mass index(BMI)and model for end-stage liver disease(MELD)score were 0.11,24.3 kg/m2 and 8.9 points,respectively.In both men and women,patients who were frail exhibited lower levels of SATI in comparison with nonfrail patients.SATI inversely correlated with Frailty Index in the entire cohort(rs=−0.1361,p=0.0332).Furthermore,SATI or TATI was independently associated with frail phenotype in several multiple logistic regression models adjusting for age,BMI,presence of ascites,sodium,Child-Pugh class or MELD score in isolation.Conclusions:In the context of decompensated cirrhosis,low SATI and concomitant TATI were associated with higher risk of being frail.These findings highlight the importance to further apply tissue-specific tools of body composition in place of crude metric like BMI.展开更多
文摘Cirrhosis serves as the final stage of various chronic liver damage,accounting for around one million deaths annually in the world.Given the clinical significance and the imperative to relieve this social as well as healthcare burden in relation to cirrhosis,a prompt and accurate evaluation of its prognostication is of the essence.In the recent years,the assessment of handgrip strength(HGS)concerning its prognostic utility among patients with cirrhosis has received intensive attention and increasing interest.Notably,the advantages to measure HGS are simple,convenient,noninvasive,cost-effective,and easy to be widely carried out during daily clinical practice.Mounting evidence demonstrates that muscle strength measured by HGS is a feasible and reliable metric to evaluate nutritional status,as well as relevant cirrhosis-related complications and mortality.Given the current lack of a landscape pertinent to prognostic performance of HGS in the context of cirrhosis,we conducted a narrative review on the predictive value of HGS in patients with cirrhosis.The validity and reliability of this metric for prognostication among cirrhosis have been comprehensively summarized,to improve the integral management and tailored therapy.
文摘Skeletal muscle and fat tissue show distinct pathophysiological roles and pivotal functions.The culmination of muscle wasting and fat accumulation represents an opposite terminal of each state.Specifically,this situation has been designated as sarcopenic obesity.However,sarcopenic obesity still lacks a unanimous definition,diagnostic criteria,and generalized modalities for assessment in the context of versatile liver diseases.Moreover,the underpinning mechanisms by which a combination of abnormal skeletal muscle and fat tissue leads to the progression of liver disease and impairs health‐related consequences are still elusive.Additionally,the interplay between skeletal muscle and fat,and the driving factors that shift different body compositions are not well understood.Therefore,in this review,we discuss skeletal muscle and fat components,with the purpose of conceptualization,as well as interpret their roles in liver diseases.We focus on the definitions,diagnostic criteria,and currently available measurements for sarcopenic obesity in the literature.We comprehensively discuss recent data and evidence regarding the potential role of sarcopenic obesity in the development and progression of numerous liver diseases and associated conditions,including nonalcoholic fatty liver disease,chronic viral hepatitis,cirrhosis,and liver transplantation.Furthermore,explicit information related to the pathogenesis of sarcopenic obesity from basic research is also provided in this narrative review.Finally,we discuss,from the clinical perspective of view,how to manage sarcopenic obesity using nutritional,physical,and pharmacological methods.
基金This study was carried out in alignment with the Declaration of Helsinki and approved by the local committee of TJMUGH(No.IRB2023-YX-013-01).
文摘Aim:Sarcopenia,multidimensional frailty,and malnutrition represent common debilitating conditions in the context of cirrhosis,linked to a variety of dismal outcomes.We aimed to clarify their overlap and cumulative impact on long-term mortality in hospitalized patients with cirrhosis.Methods:Consecutive patients with cirrhosis were prospectively recruited from January 2018 to December 2020.The diagnosis of sarcopenia,multidimensional frailty,and malnutrition was standardized according to the consensus definition and our well-documented criteria.The prevalence of the respective debilitating condition and the concurrence of this comorbidity were calculated.Results:In total,253 patients with cirrhosis aged 64 years with a female predominance(52.4%)were recruited.Sarcopenia was present in 20.9%(53/253),multidimensional frailty in 12.6%(32/253),and malnutrition in 44.7%(113/253)of the entire cohort.Approximately half of the patients had at least one debilitating condition(127/253).Sarcopenia and malnutrition co-existed in 33 nonfrail patients(13.0%)and multidimensional frailty and malnutrition in eight nonsarcopenic patients(3.2%).Fifteen(5.9%)subjects had all three debilitating conditions,namely malnutrition,sarcopenia,and frailty(MSF)group.The proportions of males,infections,and ascites were significantly higher in the MSF group.Patients in the MSF group had the highest levels of neutrophil-to-lymphocyte ratio and creatinine.The 2-year mortality rates in patients with three debilitating conditions,two conditions,one condition,and no conditions were 60.0%,23.8%,21.4%,and 13.5%,respectively.Multivariate Cox regression indicated the long-term mortality risk was approximately four-fold higher among patients in the MSF group compared to those with no conditions.Conclusions:A fraction of patients with cirrhosis exhibited comorbidities of sarcopenia,multidimensional frailty,and malnutrition,linked to a higher risk of long-term mortality.
基金supported by the Science and Technology Program of Tianjin (Grant 19ZXDBSY00020).
文摘Background and Aims:Emerging evidence has demonstrated that abnormal body composition may potentiate the development of frailty,whereas little work focuses on the role of divergent adipose tissue.Therefore,we aimed to determine the potential contribution of adipose tissue distribution to multidimensional frailty in decompensated cirrhosis.Methods:We conducted a retrospective cohort study.Divergent adipose tissues were assessed by computed tomography-derived subcutaneous adipose tissue index(SATI),visceral adipose tissue index(VATI)and total adipose tissue index(TATI),respectively.Frailty was identified by our validated self-reported Frailty Index.Multiple binary logistic models incorporating different covariates were established to assess the relationship between adipose tissue distribution and frailty.Results:The study cohort comprised 245 cirrhotic patients with 45.3%being male.The median Frailty Index,body mass index(BMI)and model for end-stage liver disease(MELD)score were 0.11,24.3 kg/m2 and 8.9 points,respectively.In both men and women,patients who were frail exhibited lower levels of SATI in comparison with nonfrail patients.SATI inversely correlated with Frailty Index in the entire cohort(rs=−0.1361,p=0.0332).Furthermore,SATI or TATI was independently associated with frail phenotype in several multiple logistic regression models adjusting for age,BMI,presence of ascites,sodium,Child-Pugh class or MELD score in isolation.Conclusions:In the context of decompensated cirrhosis,low SATI and concomitant TATI were associated with higher risk of being frail.These findings highlight the importance to further apply tissue-specific tools of body composition in place of crude metric like BMI.
