title: Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis.
abstract: OBJECTIVE
  Obesity is frequently associated with cirrhosis, and cirrhotic patients may develop simultaneous loss of skeletal muscle and gain of adipose tissue, culminating in the condition of sarcopenic obesity. Additionally, muscle depletion is characterized by both a reduction in muscle size and increased proportion of muscular fat, termed myosteatosis. In this study, we aimed to establish the frequency and clinical significance of sarcopenia, sarcopenic obesity and myosteatosis in cirrhotic patients.
  
  
  METHODS
  We analysed 678 patients with cirrhosis. Sarcopenia, sarcopenic obesity and myosteatosis were analysed by CT scan using the third lumbar vertebrae skeletal muscle and attenuation indexes, using previously validated gender-and body mass index-specific cutoffs.
  
  
  RESULTS
  Patients were predominately men (n = 457, 67%), and cirrhosis aetiology was hepatitis C virus in 269 patients (40%), alcohol in 153 (23%), non-alcoholic steatohepatitis/cryptogenic in 96 (14%), autoimmune liver disease in 55 (8%), hepatitis B virus in 43 (6%), and others in 5 patients (1%). Sarcopenia was present in 292 (43%), 135 had sarcopenic obesity (20%) and 353 had myosteatosis (52%). Patients with sarcopenia (22 ± 3 vs. 95 ± 22 months, P < 0.001), sarcopenic obesity (22 ± 3 vs. 95 ± 22 months, P < 0.001), and myosteatosis (28 ± 5 vs. 95 ± 22 months, P < 0.001) had worse median survival than patients without muscular abnormalities. By multivariate Cox regression analysis, both sarcopenia [hazard ratio (HR) 2.00, 95% confidence interval (CI) 1.44-2.77, P < 0.001], and myosteatosis (HR 1.42, 95% CI 1.02-1.07, P = 0.04) were associated with mortality.
  
  
  CONCLUSIONS
  Sarcopenia, sarcopenic obesity and myosteatosis are often present in patients with cirrhosis, and sarcopenia and myosteatosis are independently associated with a higher long-term mortality in cirrhosis.
authors: Division of Gastroenterology & Liver Unit University of Alberta Hospital Edmonton Alberta Canada.
authors: Aldo J
authors: AJ
authors: Montano-Loza
authors: Division of Digestive Diseases & Nutrition University of Kentucky Medical Center Lexington KY USA.
authors: Paul
authors: P
authors: Angulo
authors: Department of Oncology Cross Cancer Institute Edmonton Alberta Canada.
authors: Judith
authors: J
authors: Meza-Junco
authors: Department of Agricultural Food and Nutritional Sciences Edmonton Alberta Canada.
authors: Carla M M
authors: CM
authors: Prado
authors: Department of Oncology Cross Cancer Institute Edmonton Alberta Canada.
authors: Michael B
authors: MB
authors: Sawyer
authors: Department of Oncology Cross Cancer Institute Edmonton Alberta Canada.
authors: Crystal
authors: C
authors: Beaumont
authors: Department of Oncology Cross Cancer Institute Edmonton Alberta Canada.
authors: Nina
authors: N
authors: Esfandiari
authors: Division of Gastroenterology & Liver Unit University of Alberta Hospital Edmonton Alberta Canada.
authors: Mang
authors: M
authors: Ma
authors: Department of Oncology Cross Cancer Institute Edmonton Alberta Canada.
authors: Vickie E
authors: VE
authors: Baracos
keywords: Cirrhosis; Lumbar skeletal muscle index; Muscle attenuation index; Muscle depletion; Myosteatosis; Overweight