Postgraduate Program in Health in Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil.
Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada; Covenant Health Palliative Institute, Edmonton, Alberta, Canada.
Nutrition. 2023 Jun;110:112001. doi: 10.1016/j.nut.2023.112001. Epub 2023 Feb 15.
The progression of chronic liver disease is associated with metabolic alterations that compromise the patient's body composition and physical function. Muscle wasting often occurs with pathologic fat accumulation in the muscle (myosteatosis). Unfavorable changes in body composition frequently arise in conjunction with a decrease in muscle strength. These conditions are associated with worse prognoses. The aim of this study was to explore the associations between computed tomography (CT)-derived measures of muscle mass and muscle radiodensity (myosteatosis) and its correlation with muscle strength in patients with advanced chronic liver disease.
This cross-sectional study was conducted between July 2016 and July 2017. CT images at the third lumbar vertebra level (L3) were analyzed, and skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) were defined. Handgrip strength (HGS) was assessed by dynamometry. Correlations between CT-assessed body composition and HGS were tested. Multivariable linear regression was used to determine the factors associated with HGS.
We evaluated 118 patients with cirrhosis, of whom 64.4% were men. Of those evaluated, the mean age was 57.5 ± 8.5 y. Both SMI and SMD showed a positive correlation with muscle strength (r = 0.46 and 0.25, respectively); and age and Model for End-Stage Liver Disease (MELD)score showed the highest negative correlations (r = -0.37 and -0.34, respectively). In multivariable analyses, the presence of comorbidities (≥1), MELD score, and SMI were significantly associated with HGS.
Low muscle mass and clinical characteristics of disease severity may adversely affect muscle strength in patients with liver cirrhosis.
慢性肝病的进展与代谢改变有关，这些改变会影响患者的身体成分和身体功能。肌肉减少症常与肌肉内病理性脂肪堆积（肌内脂肪增多）同时发生。身体成分的不利变化常与肌肉力量下降同时发生。这些情况与预后较差有关。本研究旨在探讨 CT 衍生的肌肉质量和肌肉放射性密度（肌内脂肪增多）与晚期慢性肝病患者肌肉力量的相关性。
本横断面研究于 2016 年 7 月至 2017 年 7 月进行。分析第三腰椎水平（L3）的 CT 图像，并定义骨骼肌指数（SMI）和骨骼肌放射性密度（SMD）。通过测力仪评估手握力（HGS）。测试 CT 评估的身体成分与 HGS 之间的相关性。采用多元线性回归确定与 HGS 相关的因素。
我们评估了 118 例肝硬化患者，其中 64.4%为男性。评估患者的平均年龄为 57.5±8.5 岁。SMI 和 SMD 均与肌肉力量呈正相关（r=0.46 和 0.25）；年龄和终末期肝病模型（MELD）评分与肌肉力量的负相关最高（r=-0.37 和 -0.34）。在多变量分析中，存在合并症（≥1）、MELD 评分和 SMI 与 HGS 显著相关。
低肌肉量和疾病严重程度的临床特征可能会对肝硬化患者的肌肉力量产生不利影响。
