Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.
Clin Nutr ESPEN. 2021 Apr;42:354-360. doi: 10.1016/j.clnesp.2021.01.008. Epub 2021 Jan 27.
BACKGROUND & AIMS: The impact of obesity, evaluated using body mass index (BMI), on mortality in patients with cirrhosis is controversial. The prognostic impact of visceral fat accumulation, which is recommended as an indicator of obesity-related mortality, is still unknown. This study aimed to clarify the impact of visceral fat accumulation on mortality in patients with cirrhosis.
A total of 335 cirrhotic patients without hepatocellular carcinoma were retrospectively evaluated. The impact of obesity, defined as a visceral fat area ≥100 cm at the umbilical level or BMI ≥25 kg/m on mortality, was evaluated using competing risk analysis.
Of 355 patients, visceral fat accumulation was seen in 147 patients. During the observation period (1340 ± 980 days), 84 patients died, and 17 received liver transplantation. Visceral fat accumulation was not found to be associated with mortality (hazard ratio [HR] 1.423, P = 0.180) in any of the patients. After stratification of the patients, visceral fat accumulation was observed to be associated with a poor prognosis in patients with skeletal muscle depletion (HR 3.804, P = 0.003), but not in those without (HR 1.147, P = 0.660). On the other hand, obesity defined by BMI ≥25 kg/m was not found to be associated with mortality in patients with (HR 0.341, P = 0.390) or without skeletal muscle depletion (HR 1.227, P = 0.500).
Visceral fat accumulation is a useful index for evaluating obesity and aggravates mortality in cirrhotic patients with skeletal muscle depletion, but not in those without.
使用身体质量指数（BMI）评估肥胖对肝硬化患者死亡率的影响存在争议。内脏脂肪堆积作为肥胖相关死亡率的指标，其预后影响尚不清楚。本研究旨在阐明内脏脂肪堆积对肝硬化患者死亡率的影响。
回顾性评估了 335 例无肝细胞癌的肝硬化患者。使用竞争风险分析评估肥胖（定义为脐水平内脏脂肪面积≥100cm或 BMI≥25kg/m）对死亡率的影响。
在 355 例患者中，147 例存在内脏脂肪堆积。在观察期间（1340±980 天），84 例患者死亡，17 例患者接受了肝移植。在任何患者中，内脏脂肪堆积均与死亡率无关（风险比[HR]1.423，P=0.180）。在对患者进行分层后，在存在骨骼肌耗竭的患者中，内脏脂肪堆积与预后不良相关（HR 3.804，P=0.003），而在不存在骨骼肌耗竭的患者中则没有相关性（HR 1.147，P=0.660）。另一方面，BMI≥25kg/m 定义的肥胖与存在（HR 0.341，P=0.390）或不存在骨骼肌耗竭（HR 1.227，P=0.500）的患者的死亡率无关。
内脏脂肪堆积是评估肥胖的有用指标，它可加重存在骨骼肌耗竭的肝硬化患者的死亡率，但对不存在骨骼肌耗竭的患者则无影响。
