title: Sarcopenia impairs prognosis of patients with liver cirrhosis.
abstract: OBJECTIVE
  Sarcopenia is characterized by the loss of skeletal muscle mass, and is reported to appear in patients with liver cirrhosis (LC). The aim of this study was to investigate the prevalence of sarcopenia in patients with LC, and to test the association between sarcopenia and patient outcomes. We also analyzed the effect of branched-chain amino acid (BCAA) supplementation on sarcopenic LC.
  
  
  METHODS
  Clinical and blood biochemical data of 130 patients with LC who underwent abdominal computed tomography scan were analyzed in this retrospective study. The cross-sectional area of skeletal muscles was measured at the level of the third lumbar vertebra on the scan. The skeletal muscle index was calculated to identify sarcopenia. Cirrhotic patients who were treated with BCAA supplementation of 12 g/d for ≥ 1 y were defined as the BCAA group, and the effect of BCAA on sarcopenic LC was evaluated.
  
  
  RESULTS
  Sixty-eight percent of all patients (82% of men and 50% of women) were diagnosed with sarcopenia. Male sex (P = 0.01) and body mass index (P < 0.0001) were predictors of sarcopenia. The multivariate Cox proportional hazards model found BCAA supplementation (hazard ratio [HR], 0.38; P = 0.01), sarcopenia (HR, 3.03; P < 0.01), and Child-Pugh classes B (HR, 2.39; P = 0.03) and C (HR, 5.49; P < 0.001) to be independently associated with mortality. The mortality of sarcopenic LC was significantly higher than that of non-sarcopenic LC (P = 0.01). Moreover, BCAA supplementation improved the survival of sarcopenic patients in subgroup analysis (P < 0.01).
  
  
  CONCLUSIONS
  Sarcopenia is significantly associated with mortality in patients with LC. BCAA supplementation might be associated with improved survival of such patients.
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Hanai
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan. Electronic address: Mshiraki-gif@umin.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Shiraki
authors.affiliation: Center of Nutrition Support and Infection Control, Gifu University Hospital, Yanagido, Gifu, Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Nishimura
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan.
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Ohnishi
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Imai
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suetsugu
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takai
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan.
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage*; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D000597:Amino Acids, Branched-Chain
keywords: Branched-chain amino acids; Liver cirrhosis; Protein–energy malnutrition; Sarcopenia; Skeletal muscle index; Survival