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The Role of Changes in Subcutaneous and Visceral Adiposity, Sarcopenic Obesity, and Myosteatosis/Muscle Quality in Cirrhosis: How to Diagnose It and Its Contribution to Prognosis

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Frailty and Sarcopenia in Cirrhosis

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Abstract

Recent advances in body composition evaluation have recognized the inability of the BMI to differentiate between body compartments and limited accuracy in the presence of ascites or edema, major complications in patients with cirrhosis. By using computed tomography image-based analysis of two major body compartments, muscle and adipose tissue, sex-dependent differences in body composition have been identified in patients with cirrhosis. Abnormalities in body composition, i.e., sarcopenia, myosteatosis, high visceral adiposity, low subcutaneous adiposity, and sarcopenic obesity, are common in patients with cirrhosis and constitute important prognostic factors. Considering an association between body composition abnormalities and adverse outcomes in patients with cirrhosis, early identification of these abnormalities is critical to enable proper interventions.

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References

  1. Trayhurn P, Drevon CA, Eckel J. Secreted proteins from adipose tissue and skeletal muscle – adipokines, myokines and adipose/muscle cross-talk. Arch Physiol Biochem. 2011;117(2):47–56. https://doi.org/10.3109/13813455.2010.535835.

    Article  CAS  PubMed  Google Scholar 

  2. Ali AT, Hochfeld WE, Myburgh R, Pepper MS. Adipocyte and adipogenesis. Eur J Cell Biol. 2013;92(6–7):229–36. https://doi.org/10.1016/j.ejcb.2013.06.001.

    Article  CAS  PubMed  Google Scholar 

  3. European Association for the Study of the L, European Association for the Study of D, European Association for the Study of O. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388–402. https://doi.org/10.1016/j.jhep.2015.11.004.

    Article  Google Scholar 

  4. Dick AA, Spitzer AL, Seifert CF, Deckert A, Carithers RL Jr, Reyes JD, et al. Liver transplantation at the extremes of the body mass index. Liver Transpl. 2009;15(8):968–77. https://doi.org/10.1002/lt.21785.

    Article  PubMed  Google Scholar 

  5. Triguero J, Garcia A, Molina A, San Miguel C, Notario P, Villegas T, et al. Complications associated with liver transplantation in recipients with body mass index >35 kg/m(2): would it be a poor prognosis predictive factor? Transplant Proc. 2015;47(9):2650–2. https://doi.org/10.1016/j.transproceed.2015.10.015.

    Article  CAS  PubMed  Google Scholar 

  6. Tanaka T, Renner EL, Selzner N, Therapondos G, Lilly LB. The impact of obesity as determined by modified body mass index on long-term outcome after liver transplantation: Canadian single-center experience. Transplant Proc. 2013;45(6):2288–94. https://doi.org/10.1016/j.transproceed.2012.11.009.

    Article  CAS  PubMed  Google Scholar 

  7. Bambha KM, Dodge JL, Gralla J, Sprague D, Biggins SW. Low, rather than high, body mass index confers increased risk for post-liver transplant death and graft loss: risk modulated by model for end-stage liver disease. Liver Transpl. 2015;21(10):1286–94. https://doi.org/10.1002/lt.24188.

    Article  PubMed  Google Scholar 

  8. Goodpaster BH, Theriault R, Watkins SC, Kelley DE. Intramuscular lipid content is increased in obesity and decreased by weight loss. Metabolism. 2000;49(4):467–72.

    Article  CAS  Google Scholar 

  9. Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol. 1998;85(1):115–22. https://doi.org/10.1152/jappl.1998.85.1.115.

    Article  CAS  PubMed  Google Scholar 

  10. Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539–47. https://doi.org/10.1200/JCO.2012.45.2722.

    Article  PubMed  Google Scholar 

  11. Montano-Loza AJ, Angulo P, Meza-Junco J, Prado CM, Sawyer MB, Beaumont C, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle. 2016;7(2):126–35. https://doi.org/10.1002/jcsm.12039.

    Article  PubMed  Google Scholar 

  12. Bhanji RA, Moctezuma-Velazquez C, Duarte-Rojo A, Ebadi M, Ghosh S, Rose C, et al. Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis. Hepatol Int. 2018;12:377. https://doi.org/10.1007/s12072-018-9875-9.

    Article  PubMed  Google Scholar 

  13. Aubrey J, Esfandiari N, Baracos VE, Buteau FA, Frenette J, Putman CT, et al. Measurement of skeletal muscle radiation attenuation and basis of its biological variation. Acta Physiol. 2014;210(3):489–97. https://doi.org/10.1111/apha.12224.

    Article  CAS  Google Scholar 

  14. Stretch C, Aubin JM, Mickiewicz B, Leugner D, Al-Manasra T, Tobola E, et al. Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas. PLoS One. 2018;13(5):e0196235. https://doi.org/10.1371/journal.pone.0196235.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Miljkovic I, Zmuda JM. Epidemiology of myosteatosis. Curr Opin Clin Nutr Metab Care. 2010;13(3):260–4. https://doi.org/10.1097/MCO.0b013e328337d826.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Eslamparast T, Montano-Loza AJ, Raman M, Tandon P. Sarcopenic obesity in cirrhosis-the confluence of 2 prognostic titans. Liver Int. 2018;38(10):1706–17. https://doi.org/10.1111/liv.13876.

    Article  PubMed  Google Scholar 

  17. Geer EB, Shen W. Gender differences in insulin resistance, body composition, and energy balance. Gend Med. 2009;6(Suppl 1):60–75. https://doi.org/10.1016/j.genm.2009.02.002.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fain JN, Madan AK, Hiler ML, Cheema P, Bahouth SW. Comparison of the release of adipokines by adipose tissue, adipose tissue matrix, and adipocytes from visceral and subcutaneous abdominal adipose tissues of obese humans. Endocrinology. 2004;145(5):2273–82. https://doi.org/10.1210/en.2003-1336.

    Article  CAS  PubMed  Google Scholar 

  19. Girard J, Lafontan M. Impact of visceral adipose tissue on liver metabolism and insulin resistance. Part II: visceral adipose tissue production and liver metabolism. Diabetes Metab. 2008;34(5):439–45. https://doi.org/10.1016/j.diabet.2008.04.002.

    Article  CAS  PubMed  Google Scholar 

  20. Ebadi M, Baracos VE, Bathe OF, Robinson LE, Mazurak VC. Loss of visceral adipose tissue precedes subcutaneous adipose tissue and associates with n-6 fatty acid content. Clin Nutr. 2016;35(6):1347–53. https://doi.org/10.1016/j.clnu.2016.02.014.

    Article  CAS  PubMed  Google Scholar 

  21. Ebadi M, Tandon P, Moctezuma-Velazquez C, Ghosh S, Baracos VE, Mazurak VC, et al. Low subcutaneous adiposity associates with higher mortality in female patients with cirrhosis. J Hepatol. 2018;69(3):608–16. https://doi.org/10.1016/j.jhep.2018.04.015.

    Article  PubMed  Google Scholar 

  22. Fujiwara N, Nakagawa H, Kudo Y, Tateishi R, Taguri M, Watadani T, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol. 2015;63(1):131–40. https://doi.org/10.1016/j.jhep.2015.02.031.

    Article  CAS  PubMed  Google Scholar 

  23. Terjimanian MN, Harbaugh CM, Hussain A, Olugbade KO Jr, Waits SA, Wang SC, et al. Abdominal adiposity, body composition and survival after liver transplantation. Clin Transpl. 2016;30(3):289–94. https://doi.org/10.1111/ctr.12688.

    Article  Google Scholar 

  24. Cruz RJ Jr, Dew MA, Myaskovsky L, Goodpaster B, Fox K, Fontes P, et al. Objective radiologic assessment of body composition in patients with end-stage liver disease: going beyond the BMI. Transplantation. 2013;95(4):617–22. https://doi.org/10.1097/TP.0b013e31827a0f27.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Montano-Loza AJ, Mazurak VC, Ebadi M, Meza-Junco J, Sawyer MB, Baracos VE, et al. Visceral adiposity increases risk for hepatocellular carcinoma in male patients with cirrhosis and recurrence after liver transplant. Hepatology. 2018;67(3):914–23. https://doi.org/10.1002/hep.29578.

    Article  PubMed  Google Scholar 

  26. Mattiasson I, Rendell M, Tornquist C, Jeppsson S, Hulthen UL. Effects of estrogen replacement therapy on abdominal fat compartments as related to glucose and lipid metabolism in early postmenopausal women. Horm Metab Res. 2002;34(10):583–8. https://doi.org/10.1055/s-2002-35420.

    Article  CAS  PubMed  Google Scholar 

  27. Hassan MM, Botrus G, Abdel-Wahab R, Wolff RA, Li D, Tweardy D, et al. Estrogen replacement reduces risk and increases survival times of women with hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2017;15(11):1791–9. https://doi.org/10.1016/j.cgh.2017.05.036.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17(6):445–50.

    Article  CAS  Google Scholar 

  29. Figueiredo FA, De Mello Perez R, Kondo M. Effect of liver cirrhosis on body composition: evidence of significant depletion even in mild disease. J Gastroenterol Hepatol. 2005;20(2):209–16. https://doi.org/10.1111/j.1440-1746.2004.03544.x.

    Article  PubMed  Google Scholar 

  30. Kobayashi A, Kaido T, Hamaguchi Y, Okumura S, Shirai H, Yao S, et al. Impact of sarcopenic obesity on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg. 2017;269:924. https://doi.org/10.1097/SLA.0000000000002555.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada

    Maryam Ebadi & Aldo J. Montano-Loza

Authors
  1. Maryam Ebadi
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  2. Aldo J. Montano-Loza
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Correspondence to Maryam Ebadi .

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Editors and Affiliations

  1. Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada

    Puneeta Tandon

  2. Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada

    Aldo J. Montano-Loza

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Ebadi, M., Montano-Loza, A.J. (2020). The Role of Changes in Subcutaneous and Visceral Adiposity, Sarcopenic Obesity, and Myosteatosis/Muscle Quality in Cirrhosis: How to Diagnose It and Its Contribution to Prognosis. In: Tandon, P., Montano-Loza, A. (eds) Frailty and Sarcopenia in Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-030-26226-6_10

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  • DOI: https://doi.org/10.1007/978-3-030-26226-6_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26225-9

  • Online ISBN: 978-3-030-26226-6

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