Myosteatosis, low BMI and low alanine aminotransferase levels correlate with skeletal volume loss in patients with chronic liver disease, especially among women, according to recently published data.
“Severe skeletal muscle volume loss has more recently been recognized as an indicator of cachexia and appears to be a strong negative prognostic factor in cirrhosis and several chronic diseases, as well as in malignancies, irrespective of cancer diagnosis, stage, and treatment,” Yoshihiko Tachi, MD, from the Komaki City Hospital, Japan, and colleagues wrote. “The results of the present study demonstrate that myosteatosis may serve as a novel biomarker for prognosis in patients with chronic liver disease who frequently undergo [computed tomography (CT)] as part of surveillance programs.”
Tachi and colleagues hypothesized that myosteatosis a role in decreasing skeletal muscle mass in patients with chronic liver disease.
To investigate the effects of myosteatosis, the researchers enrolled 362 patients with chronic liver disease, including 94 patients with cirrhosis. Mean skeletal muscle index (SMI) was 42.9 and mean skeletal muscle attenuation level was 31.9 Hounsfield units (HU).
SMI values decreased significantly with age in both men (P = .001) and women (P = .035). SMI values were lower for women compared with men at the same age range. Similarly, skeletal muscle attenuation values decreased significantly with age for both men (P < .001) and women (P < .001) and were lower for women than men at the same age range.
Multivariate analysis showed that lower BMI levels (OR = 5.26; 95% CI, 3.21-8.54), presence of myosteatosis (OR = 2.82; 95% CI, 1.26-6.3), lower ALT levels (OR = 2.04; 95% CI, 1.18-3.52) and female sex (OR = 1.71; 95% CI 1.04-2.28) correlated significantly with skeletal muscle volume loss in patients with chronic liver disease.
Multivariate analysis also demonstrated that higher age (OR = 5.86; 95% CI, 3.03-11.41, female sex (OR = 5.43; 95% CI, 2.58-11.41), presence of skeletal muscle volume loss (OR = 2.81; 95% CI, 1.25-6.29), and higher subcutaneous adipose tissue area ratio levels (OR = 2.08; 95% CI 1.01-4.28) correlated significantly with the presence of myosteatosis in patients with chronic liver disease.
While the cumulative incidence of hepatocellular carcinoma was similar regardless of presence absence of muscle volume loss, HCC occurred significantly more often in patients with myosteatosis (P = .038).
“Previous studies have reported that sarcopenia is important negative predictor of prognosis in patients with chronic liver disease,” the researchers wrote. “Therefore, these patients should undergo intensive exercise and receive nutritional support. It was reported that walking exercise and branched chain amino acid supplementation contributed to improvement of skeletal muscle volume and strength in liver cirrhosis patients. The degree of skeletal muscle attenuation may have utility in identifying patients with muscle wasting and impaired nutritional status who may benefit from intensive nutritional and exercise support.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.