title: Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation.
abstract: BACKGROUND
  Sarcopenia is the most common complication of cirrhosis and adversely affects quality of life and outcomes before, during, and after liver transplantation. We studied predictors of sarcopenia and sarcopenic obesity in patients with cirrhosis undergoing liver transplant (LT) evaluation.
  
  
  METHODS
  A retrospective analysis of 207 adult cirrhotic patients that underwent LT from January 2008 to December 2013 was performed at our institution.
  
  
  RESULTS
  Two hundred seven patients were evaluated, 68% were male with a mean age of 54 ± 8 years. The most common etiology of cirrhosis was alcoholic liver disease (38.6%), followed by chronic hepatitis C (38.2%), nonalcoholic steatohepatitis (NASH) (21.7%), and hepatocellular carcinoma (HCC) (24.6%). The mean body mass index of the cohort was of 30.1 ± 5.7 kg/m(2) . Forty-eight percent of these patients were obese. Of the 207 patients, 88% had computed tomographic (CT) scans within 90 days before transplant; of these, 59% had sarcopenia found during LT evaluation. Of the patients with pretransplant sarcopenia, 59 had CT scan at 6 months posttransplant and 56 (95%) remained sarcopenic. Of the 56 patients who had sarcopenia at 6 months, 31 had available CT scans at 1 year, and 100% persisted with sarcopenia. These 31 subjects had a mean skeletal muscle index of 35 at 6 months and 36 at 1 year. SO was found in 41.7% of our patients. On multivariable regression analysis, obesity and age were found to be independently associated with pretransplant sarcopenia after controlling for gender and alcohol liver disease diagnosis (P = 0.00001, odds ratio [OR] 0.22, and P = 0.008, OR 2.0, respectively). A multivariable logistic regression analysis found that NASH as cause of cirrhosis and model of end-stage liver disease score are independent predictors of sarcopenic obesity after controlling for age, gender, alcoholic liver disease diagnosis, and HCC (P = 0.014 and 0.038, respectively; 95% confidence interval, 1.44-25.26 and 1.00-1.15, respectively; OR 6.03, 1.08, respectively).
  
  
  CONCLUSIONS
  Sarcopenia and sarcopenic obesity is seen in a significant number of patients with cirrhosis undergoing LT evaluation. Sarcopenia progresses after LT initially and does not recover at least within the first year after surgery. Obesity is an independent predictor of pretransplant sarcopenia and NASH was associated with 6-fold increased risk of having sarcopenic obesity in cirrhotic patients in our cohort.
authors.affiliation: Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Carias
authors.affiliation: Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Ana Lia
authors.initials: AL
authors.lastname: Castellanos
authors.affiliation: Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Valery
authors.initials: V
authors.lastname: Vilchez
authors.affiliation: Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Nair
authors.affiliation: Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Anna Christina
authors.initials: AC
authors.lastname: Dela Cruz
authors.affiliation: Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Watkins
authors.affiliation: Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Terrence
authors.initials: T
authors.lastname: Barrett
authors.affiliation: Division of Digestive Diseases and Nutrition, College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Patel
authors.initials: P
authors.lastname: Trushar
authors.affiliation: Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Karyn
authors.initials: K
authors.lastname: Esser
authors.affiliation: Department of Surgery, Division of Transplantation College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gedaly
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012306:Risk; D055948:Sarcopenia / Q000209:etiology*; D015996:Survival Rate; D055815:Young Adult
keywords: cirrhosis; liver transplantation; obesity; sarcopenia