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Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation.
J Gastroenterol Hepatol 2016; 31(3):628-33JG

Abstract

BACKGROUND

Sarcopenia is the most common complication of cirrhosis and adversely affects quality of life and outcomes before, during, and after liver transplantation. We studied predictors of sarcopenia and sarcopenic obesity in patients with cirrhosis undergoing liver transplant (LT) evaluation.

METHODS

A retrospective analysis of 207 adult cirrhotic patients that underwent LT from January 2008 to December 2013 was performed at our institution.

RESULTS

Two hundred seven patients were evaluated, 68% were male with a mean age of 54 ± 8 years. The most common etiology of cirrhosis was alcoholic liver disease (38.6%), followed by chronic hepatitis C (38.2%), nonalcoholic steatohepatitis (NASH) (21.7%), and hepatocellular carcinoma (HCC) (24.6%). The mean body mass index of the cohort was of 30.1 ± 5.7 kg/m(2) . Forty-eight percent of these patients were obese. Of the 207 patients, 88% had computed tomographic (CT) scans within 90 days before transplant; of these, 59% had sarcopenia found during LT evaluation. Of the patients with pretransplant sarcopenia, 59 had CT scan at 6 months posttransplant and 56 (95%) remained sarcopenic. Of the 56 patients who had sarcopenia at 6 months, 31 had available CT scans at 1 year, and 100% persisted with sarcopenia. These 31 subjects had a mean skeletal muscle index of 35 at 6 months and 36 at 1 year. SO was found in 41.7% of our patients. On multivariable regression analysis, obesity and age were found to be independently associated with pretransplant sarcopenia after controlling for gender and alcohol liver disease diagnosis (P = 0.00001, odds ratio [OR] 0.22, and P = 0.008, OR 2.0, respectively). A multivariable logistic regression analysis found that NASH as cause of cirrhosis and model of end-stage liver disease score are independent predictors of sarcopenic obesity after controlling for age, gender, alcoholic liver disease diagnosis, and HCC (P = 0.014 and 0.038, respectively; 95% confidence interval, 1.44-25.26 and 1.00-1.15, respectively; OR 6.03, 1.08, respectively).

CONCLUSIONS

Sarcopenia and sarcopenic obesity is seen in a significant number of patients with cirrhosis undergoing LT evaluation. Sarcopenia progresses after LT initially and does not recover at least within the first year after surgery. Obesity is an independent predictor of pretransplant sarcopenia and NASH was associated with 6-fold increased risk of having sarcopenic obesity in cirrhotic patients in our cohort.

Authors+Show Affiliations

Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26399838

Citation

Carias, Sandra, et al. "Nonalcoholic Steatohepatitis Is Strongly Associated With Sarcopenic Obesity in Patients With Cirrhosis Undergoing Liver Transplant Evaluation." Journal of Gastroenterology and Hepatology, vol. 31, no. 3, 2016, pp. 628-33.
Carias S, Castellanos AL, Vilchez V, et al. Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. J Gastroenterol Hepatol. 2016;31(3):628-33.
Carias, S., Castellanos, A. L., Vilchez, V., Nair, R., Dela Cruz, A. C., Watkins, J., ... Gedaly, R. (2016). Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. Journal of Gastroenterology and Hepatology, 31(3), pp. 628-33. doi:10.1111/jgh.13166.
Carias S, et al. Nonalcoholic Steatohepatitis Is Strongly Associated With Sarcopenic Obesity in Patients With Cirrhosis Undergoing Liver Transplant Evaluation. J Gastroenterol Hepatol. 2016;31(3):628-33. PubMed PMID: 26399838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. AU - Carias,Sandra, AU - Castellanos,Ana Lia, AU - Vilchez,Valery, AU - Nair,Rashmi, AU - Dela Cruz,Anna Christina, AU - Watkins,Jennifer, AU - Barrett,Terrence, AU - Trushar,Patel, AU - Esser,Karyn, AU - Gedaly,Roberto, PY - 2015/09/16/accepted PY - 2015/9/25/entrez PY - 2015/9/25/pubmed PY - 2016/12/15/medline KW - cirrhosis KW - liver transplantation KW - obesity KW - sarcopenia SP - 628 EP - 33 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 31 IS - 3 N2 - BACKGROUND: Sarcopenia is the most common complication of cirrhosis and adversely affects quality of life and outcomes before, during, and after liver transplantation. We studied predictors of sarcopenia and sarcopenic obesity in patients with cirrhosis undergoing liver transplant (LT) evaluation. METHODS: A retrospective analysis of 207 adult cirrhotic patients that underwent LT from January 2008 to December 2013 was performed at our institution. RESULTS: Two hundred seven patients were evaluated, 68% were male with a mean age of 54 ± 8 years. The most common etiology of cirrhosis was alcoholic liver disease (38.6%), followed by chronic hepatitis C (38.2%), nonalcoholic steatohepatitis (NASH) (21.7%), and hepatocellular carcinoma (HCC) (24.6%). The mean body mass index of the cohort was of 30.1 ± 5.7 kg/m(2) . Forty-eight percent of these patients were obese. Of the 207 patients, 88% had computed tomographic (CT) scans within 90 days before transplant; of these, 59% had sarcopenia found during LT evaluation. Of the patients with pretransplant sarcopenia, 59 had CT scan at 6 months posttransplant and 56 (95%) remained sarcopenic. Of the 56 patients who had sarcopenia at 6 months, 31 had available CT scans at 1 year, and 100% persisted with sarcopenia. These 31 subjects had a mean skeletal muscle index of 35 at 6 months and 36 at 1 year. SO was found in 41.7% of our patients. On multivariable regression analysis, obesity and age were found to be independently associated with pretransplant sarcopenia after controlling for gender and alcohol liver disease diagnosis (P = 0.00001, odds ratio [OR] 0.22, and P = 0.008, OR 2.0, respectively). A multivariable logistic regression analysis found that NASH as cause of cirrhosis and model of end-stage liver disease score are independent predictors of sarcopenic obesity after controlling for age, gender, alcoholic liver disease diagnosis, and HCC (P = 0.014 and 0.038, respectively; 95% confidence interval, 1.44-25.26 and 1.00-1.15, respectively; OR 6.03, 1.08, respectively). CONCLUSIONS: Sarcopenia and sarcopenic obesity is seen in a significant number of patients with cirrhosis undergoing LT evaluation. Sarcopenia progresses after LT initially and does not recover at least within the first year after surgery. Obesity is an independent predictor of pretransplant sarcopenia and NASH was associated with 6-fold increased risk of having sarcopenic obesity in cirrhotic patients in our cohort. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/26399838/Nonalcoholic_steatohepatitis_is_strongly_associated_with_sarcopenic_obesity_in_patients_with_cirrhosis_undergoing_liver_transplant_evaluation_ L2 - https://doi.org/10.1111/jgh.13166 DB - PRIME DP - Unbound Medicine ER -