全球营养不良领导倡议定义的营养不良与内脏肥胖并存预测失代偿性肝硬化住院患者的长期全因死亡率更差。

Global Leadership Initiative on Malnutrition-defined malnutrition coexisting with visceral adiposity predicted worse long-term all-cause mortality among inpatients with decompensated cirrhosis.

机构信息

Department of Health Management, Tianjin Hospital, No. 406 Jiefang South Road, Hexi District, Tianjin, 300211, China.

Department of Gastroenterology, Nanjing Drum Tower Hospital, Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210008, Jiangsu, China.

出版信息

Nutr Diabetes. 2024 Sep 27;14(1):76. doi: 10.1038/s41387-024-00336-9.

DOI:10.1038/s41387-024-00336-9

PMID:39333477

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11436742/

Abstract

BACKGROUND/OBJECTIVES: Malnutrition coexisting with abdominal adipose tissue accumulation bring a double burden on prognosis. More recently, the Global Leadership Initiative on Malnutrition (GLIM) has reached a novel consensus concerning the diagnostic criteria, that is, a two-step modality combining nutritional risk screening and subsequent phenotypic/etiologic parameters for comprehensive evaluation in hopes of harmonizing the malnutrition diagnosis. We aimed to elucidate their synergistic impact among inpatients with decompensated cirrhosis concerning long-term mortality.

SUBJECTS/METHODS: Malnutrition, visceral obesity, and visceral adiposity were defined by the Global Leadership Initiative on Malnutrition (GLIM), visceral fat area (VFA), and visceral to subcutaneous adipose tissue area ratio (VSR) on computed tomography, respectively. Accordingly, the patients were categorized into different groups given their nutritional status and visceral obesity/adiposity. Multivariate Cox regression was performed to identify independent risk factors associated with 1-year all-cause mortality. Kaplan-Meier curves with log-rank tests were compared among distinct groups.

RESULTS

Totally, 295 patients were recruited. GLIM, VFA, and VSR identified 131 (44.4%), 158 (53.6%), and 59 (20%) patients with malnutrition, visceral obesity and visceral adiposity, respectively. Malnutrition coexisted with visceral obesity in 55 (MO group) relative to visceral adiposity in 40 patients (MA group). Multivariate Cox analysis showed that MA (hazard ratio: 2.48; 95% confidence interval: 1.06, 5.79; P = 0.036) was independently associated with dire outcome rather than MO. Moreover, patients with cirrhosis in the MA group had the worst survival status when compared with other groups (log-rank test: P < 0.001).

CONCLUSIONS

The current study indicated that coexisting GLIM-defined malnutrition and VSR-defined visceral adiposity were in relation to worse long-term mortality among inpatients. It is imperative to delicately manage nutritional status and provide personalized treatment in this vulnerable subgroup for achieving better prognosis.

摘要

背景/目的：营养不良合并腹部脂肪组织堆积对预后造成双重负担。最近，全球营养不良领导倡议（GLIM）就诊断标准达成了新的共识，即结合营养风险筛查和随后的表型/病因参数进行综合评估的两步模式，以期协调营养不良的诊断。我们旨在阐明营养不良、内脏肥胖和内脏脂肪之间的协同作用，这些因素与失代偿性肝硬化患者的长期死亡率有关。

方法

采用全球营养不良领导倡议（GLIM）定义营养不良、内脏肥胖和内脏脂肪，通过计算机断层扫描（CT）定义内脏脂肪面积（VFA）和内脏与皮下脂肪组织面积比（VSR），并根据营养状况和内脏肥胖/脂肪将患者分为不同组。多变量 Cox 回归分析确定与 1 年全因死亡率相关的独立危险因素。使用对数秩检验比较不同组之间的 Kaplan-Meier 曲线。

结果

共纳入 295 例患者。GLIM、VFA 和 VSR 分别确定了 131 例（44.4%）、158 例（53.6%）和 59 例（20%）营养不良、内脏肥胖和内脏脂肪患者。55 例患者（MO 组）存在营养不良合并内脏肥胖，40 例患者（MA 组）存在内脏脂肪。多变量 Cox 分析显示，MA（风险比：2.48；95%置信区间：1.06，5.79；P=0.036）与不良结局独立相关，而不是 MO。此外，与其他组相比，MA 组的肝硬化患者的生存状况最差（对数秩检验：P<0.001）。