Mao Lihong, Li Chaoqun, Wang Xiaoyu, Sun Mingyu, Li Yifan, Yu Zihan, Cui Binxin, Guo Gaoyue, Yang Wanting, Hui Yangyang, Fan Xiaofei, Zhang Jie, Jiang Kui, Sun Chao
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.
Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China.
J Clin Transl Hepatol. 2023 Feb 28;11(1):58-66. doi: 10.14218/JCTH.2022.00027. Epub 2022 Apr 20.
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.
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.
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/m 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 (r=-0.1361, =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.
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.
新出现的证据表明，异常的身体组成可能会加剧衰弱的发展，而很少有研究关注不同脂肪组织的作用。因此，我们旨在确定脂肪组织分布对失代偿期肝硬化患者多维衰弱的潜在影响。
我们进行了一项回顾性队列研究。分别通过计算机断层扫描得出的皮下脂肪组织指数（SATI）、内脏脂肪组织指数（VATI）和总脂肪组织指数（TATI）来评估不同的脂肪组织。通过我们验证过的自我报告衰弱指数来识别衰弱。建立了包含不同协变量的多个二元逻辑模型，以评估脂肪组织分布与衰弱之间的关系。
研究队列包括245例肝硬化患者，其中45.3%为男性。衰弱指数、体重指数（BMI）和终末期肝病模型（MELD）评分的中位数分别为0.11、24.3kg/m²和8.9分。在男性和女性中，衰弱患者的SATI水平均低于非衰弱患者。在整个队列中，SATI与衰弱指数呈负相关（r=-0.1361，P=0.0332）。此外，在几个分别调整了年龄、BMI、腹水、钠、Child-Pugh分级或MELD评分的多元逻辑回归模型中，SATI或TATI与衰弱表型独立相关。
在失代偿期肝硬化的情况下，低SATI和伴随的TATI与更高的衰弱风险相关。这些发现凸显了进一步应用特定组织的身体组成工具来取代BMI等粗略指标的重要性。
