Agreement and diagnostic differences among three definitions of sarcopenia in patients with chronic hepatitis C.

BACKGROUND: There is neither a gold standard definition nor a universal consensus to diagnose sarcopenia in patients with chronic hepatitis C. Thus, we aimed to compare the prevalence of sarcopenia and the agreement and discrepancies between European Working Group on Sarcopenia in Older People (EWGSOP1), EWGSOP2, and Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project (FNIH) definitions in chronic hepatitis C. METHODS: Dual-energy x-ray absorptiometry was used to assess muscle mass by quantifying appendicular lean mass (ALM) adjusted for squared height (ALM/ht2 ) or for body mass index (ALMBMI ). Muscle function was evaluated by handgrip strength. Subjective Global Assessment was used to assess the nutrition status. RESULTS: This cross-sectional study included 103 outpatients (mean age, 50.6 ± 11.3 years; 33.0% with compensated cirrhosis). Sarcopenia prevalence was 8.7%, 9.7%, and 9.7%, according to EWGSOP1, EWGSOP2, and FNIH definitions, respectively. There was neither a sex- nor a liver disease severity-specific difference in the prevalence of sarcopenia between the criteria applied. Sixteen (15.5%) patients fulfilled at least one of these criteria, and 3 out of 16 (18.8%) simultaneously had sarcopenia by consensus of the three criteria. Sarcopenic obesity was identified in 9 out of 16 (56.3%) patients, and 6 out of 9 (66.7%) of these only met FNIH consensus. CONCLUSIONS: In patients without cirrhosis or with compensated cirrhosis, and with chronic hepatitis C, the agreement between EWGSOP1 and EWGSOP2 classifications was substantial for sarcopenia diagnosis. Concerning EWGSOP and FNIH criteria, a fair agreement and limited overlap were found in these patients.

Derivation and validation of a simple anthropometric equation to predict fat-free mass in patients with chronic hepatitis C.

BACKGROUND: Loss of skeletal muscle mass is very common in chronic liver diseases and affects 30.0-70.0% of the patients with cirrhosis. Given the relevance of muscle wasting in hepatic diseases, a practical screening tool for earlier detection of skeletal muscle mass loss is of utmost significance. AIMS: To develop and validate a simple anthropometric prediction equation for fat-free mass estimation by using Bioelectrical Impedance Analysis (BIA) as a reference method in patients with chronic hepatitis C (CHC). METHODS: We prospectively, included 209 CHC patients, randomly allocated into two groups, 158 patients in a development model (derivation sample) and 51 patients in a validation group (validation sample). Predictive equations were developed using backward stepwise multiple regression and the most adequate and simplest derived predictive equation was further explored for agreement and bias in the validation sample. The accuracy of the predictive equation was evaluated using the coefficient of determination (R2). RESULTS: The predictive equation with an optimal R2 was Fat-Free Mass (Kg) = Sex × 0.17 + Height (m) × 16.83 + Weight (Kg) × 0.62 + Waist Circumference (cm) × (-0.15) + Weight (Kg) × Sex × (-0.30) + Sex × Waist Circumference (cm) × 0.14-6.23; where sex = 1 for female and 0 for male. R2 = 0.93, standard error of the estimate = 2.6 Kg and coefficient of variation = 20.0%, p < 0.001. CONCLUSIONS: Our developed and cross-validated anthropometric prediction equation for fat-free mass estimation by using BIA attained a high coefficient of determination, a low standard error of the estimate, and lowermost coefficient of variation. This study indicates that predictive equations may be reliable and useful alternative methods for clinical evaluation of fat-free mass in patients with CHC.

Skeletal muscle mass index and phase angle are decreased in individuals with dependence on alcohol and other substances.

OBJECTIVE: The aim of this study was to evaluate whether low skeletal muscle mass index (SMI) and low phase angle (PhA) are associated with demographic, clinical, lifestyle, and nutritional status in patients dependent on alcohol and other substances. METHODS: We prospectively included 63 individuals dependent on alcohol and other substances and 71 age- and sex-matched healthy controls. Body composition was assessed by bioelectrical impedance analysis. Subjective global assessment was used to evaluate malnutrition. All included participants underwent a psychiatric evaluation, including the administration of the Mini-International Neuropsychiatric Interview. Univariate and multivariate analysis were performed to evaluate associations between low skeletal muscle mass index (SMI) and low phase angle (PhA) and nutritional, lifestyle, and alcohol use and cocaine/crack use variables, controlling for sex and age. RESULTS: Low SMI and low PhA were identified in 11.1% and 44.5% of the substance dependents, respectively. Low midarm muscle circumference (r = 0.58; P < 0.001), low midarm muscle area (r = 051; P < 0.001), and reduced PhA (r = 0.59; P < 0.001) were positively correlated with low SMI. Multivariate analysis showed that heavy alcohol consumption (≥80 g·d· ≥5 y-1; odds ratio [OR], 2.33; 95% confidence interval [CI], 1.12-4.84; P = 0.02) and sedentary lifestyle (OR, 4.39; 95% CI, 1.29-14.89; P = 0.02) were independently associated with reduced SMI. Low PhA was independently associated with heavy alcohol consumption (OR, 3.64; 95% CI, 1.62-8.15; P = 0.002) and cocaine or crack use (OR, 3.97; 95% CI, 1.05-15.11; P = 0.04) in multivariate analysis. CONCLUSIONS: Low SMI and low PhA are independently associated with heavy alcohol consumption. Low PhA is independently associated with cocaine or crack use.

SARCOPENIA, OBESITY AND SARCOPENIC OBESITY IN LIVER TRANSPLANTATION: A BODY COMPOSITION PROSPECTIVE STUDY.

BACKGROUND: Sarcopenia is prevalent before liver transplantation, and it is considered to be a risk factor for morbidity/mortality. After liver transplantation, some authors suggest that sarcopenia remains, and as patients gain weight as fat, they reach sarcopenic obesity status. AIM: Prospectively to assess changes in body composition, prevalence and associated factors with respect to sarcopenia, obesity and sarcopenic obesity after transplantation. METHODS: Patients were evaluated at two different times for body composition, 4.0±3.2y and 7.6±3.1y after transplantation. Body composition data were obtained using bioelectrical impedance. The fat-free mass index and fat mass index were calculated, and the patients were classified into the following categories: sarcopenic; obesity; sarcopenic obesity. RESULTS: A total of 100 patients were evaluated (52.6±13.3years; 57.0% male). The fat-free mass index decreased (17.9±2.5 to 17.5±3.5 kg/m2), fat mass index increased (8.5±3.5 to 9.0±4.0; p<0.05), prevalence of sarcopenia (19.0 to 22.0%), obesity (32.0 to 37.0%) and sarcopenic obesity (0 to 2.0%) also increased, although not significantly. The female gender was associated with sarcopenia. CONCLUSION: The fat increased over the years after surgery and the lean mass decreased, although not significantly. Sarcopenia and obesity were present after transplantation; however, sarcopenic obesity was not a reality observed in these patients.

Sarcopenia, obesity and sarcopenic obesity in liver transplantation: a body composition prospective study / Sarcopenia, obesidade e obesidade sarcopênica em pacientes submetidos ao transplante hepático: estudo prospectivo de composição corporal

ABSTRACT Background: Sarcopenia is prevalent before liver transplantation, and it is considered to be a risk factor for morbidity/mortality. After liver transplantation, some authors suggest that sarcopenia remains, and as patients gain weight as fat, they reach sarcopenic obesity status. Aim: Prospectively to assess changes in body composition, prevalence and associated factors with respect to sarcopenia, obesity and sarcopenic obesity after transplantation. Methods: Patients were evaluated at two different times for body composition, 4.0±3.2y and 7.6±3.1y after transplantation. Body composition data were obtained using bioelectrical impedance. The fat-free mass index and fat mass index were calculated, and the patients were classified into the following categories: sarcopenic; obesity; sarcopenic obesity. Results: A total of 100 patients were evaluated (52.6±13.3years; 57.0% male). The fat-free mass index decreased (17.9±2.5 to 17.5±3.5 kg/m2), fat mass index increased (8.5±3.5 to 9.0±4.0; p<0.05), prevalence of sarcopenia (19.0 to 22.0%), obesity (32.0 to 37.0%) and sarcopenic obesity (0 to 2.0%) also increased, although not significantly. The female gender was associated with sarcopenia. Conclusion: The fat increased over the years after surgery and the lean mass decreased, although not significantly. Sarcopenia and obesity were present after transplantation; however, sarcopenic obesity was not a reality observed in these patients.

RESUMO Racional: A sarcopenia é prevalente antes do transplante de fígado e é considerada fator de risco para morbidade/mortalidade desses pacientes. Após o transplante hepático, alguns autores sugerem que a sarcopenia permanece, e os pacientes ganham peso na forma de gordura, atingindo o status de obesidade sarcopênica. Objetivo: Avaliar prospectivamente as mudanças na composição corporal, prevalência e fatores associados em relação à sarcopenia, obesidade e obesidade sarcopênica após o transplante. Métodos: Os pacientes foram avaliados em dois momentos diferentes para composição corporal, 4,0±3,2 e 7,6±3,1 anos e após o transplante. Os dados da composição corporal foram obtidos por meio de bioimpedância elétrica. O índice de massa livre de gordura e o índice de massa gorda foram calculados, e os pacientes foram classificados nas seguintes categorias: sarcopênico; obesidade; obesidade sarcopênica. Resultados: Foram avaliados 100 pacientes (52,6±13,3 anos; 57,0% homens). A prevalência de sarcopenia (19,0% para 22,0%), obesidade (32,0% para 37,0%) e índice de massa livre de gordura (17,9±2,5 para 17,5±3,5 kg/m2), índice de massa gorda aumentou (8,5±3,5 para 9,0±4,0 kg/m2), e obesidade sarcopênica (0 para 2,0%) também aumentaram, embora não significativamente. O gênero feminino foi associado à sarcopenia. Conclusão: Após a operação, a gordura aumentou ao longo dos anos e a massa magra diminuiu, embora não significativamente. A sarcopenia e a obesidade estavam presentes após o transplante; no entanto, a obesidade sarcopênica não foi realidade observada nesses pacientes.

Fatores associados ao excesso de peso e ao índice de massa corporal em três escolas de Itaúna ? MG / Factors associated with overweight and body mass index in three schools of Itaúna ? MG

Objetivo: verificar a prevalência e os fatores associados ao excesso de peso e ao índice de massa corporal (IMC) de escolares. Métodos: trata-se de estudo transversal, epidemiológico, no qual foram avaliadas 60 crianças de seis a 10 anos de idade, de três escolas públicas de Itaúna-MG. Elas foram classificadas quanto ao IMC/idade e seus pais responderam a questionário para obtenção de dados demográficos, história familiar e pregressa, estilo de vida e frequência alimentar semiquantitativo. Os dados foram avaliados com auxílio dos softwares Excel e SPSS. Foram usados testes estatísticos de regressão logística múltipla e linear múltipla. Resultados: a prevalência de excesso de peso, eutrofia e baixo peso identificada pelo IMC/idade foi de 21,6% (p=13), 76,7% (p=46) e 1,7% (p=1), respectivamente. O excesso de peso foi independentemente associado à obesidade materna (p=0,004). Foi encontrada associaçãodireta entre IMC e obesidade materna (p=0,02), ingestão de pães (p=0,03) e salgadinhos tipo chips (p=0,08) e associação inversa entre IMC e ingestão de iogurte (p=0,007) e sorvete (p=0,09). Conclusão: a prevalência de excesso de peso encontrada na população estudada foi alta, demonstrando a importância de mais atenção a esse aspecto, uma vez que ele pode estar associado a fatores potencialmente modificáveis, como os dietéticos.

Objective: to verify the prevalence and factors associated with overweight and body mass index (BMI) in schoolchildren. Methods: this was a cross sectional epidemiological study in which 60 children from six to 10 years of age were evaluated in three public schools of Itaúna-MG. They were classified by BMI/age, and their parents answered a questionnaire about demographic data, medical and family history, lifestyle, and semi quantitative food frequency. The data were evaluated with the aid of the Excel and SPSS software. Statistical tests for logistic and linear multiple regressions were used. Results: the prevalence of overweight, eutrophy, and low weight, identified by BMI/age, amounted to 21.6% (p = 13),76.7% (p = 46), and 1.7% (p = 1), respectively. Overweight was independently associated with maternal obesity (p = 0.004). A direct association was found between BMI and maternal obesity (p = 0.02), intake of breads (p = 0.03) and snacks such as chips (p = 0.08), and an inverse association was observed between BMI and yogurt (p = 0.007) and ice cream (p = 0.09) intake. Conclusion: the prevalence of overweight found in the studied population was high demonstrating the importance of more attention to this aspect because it can be associated with potentially modifiable factors, such as dietetics.

Atividade física e hepatite C crônica / Physical activity and chronic hepatitis C

A hepatite crônica causada pelo vírus C (VHC) constitui problema relevante de saúde pública no mundo. A infecção associada a esse vírus é considerada causa significativa de cirrose e respectivas complicações: hipertensão portal, descompensação da função hepática e carcinoma hepatocelular. A atividade física é amplamente incentivada no tratamento de diversas doenças crônicas. Entretanto, pouco tem sido pesquisado sobre o efeito da atividade física no curso evolutivo da hepatopatia associada ao VHC. Ainda, sabe-se que indivíduos com hepatite C crônica podem desenvolver outras afecções devido à inatividade física que podem interferir no curso da doença viral. Portanto, o objetivo do presente estudo foi realizar revisão bibliográfica sobre a relação entre atividade física e hepatite C crônica.

Chronic hepatitis caused by hepatitis C virus (HCV) is relevant for the public health problem in the world. The infection associated with this virus is considered a significant cause of cirrhosis and its complications: portal hypertension, decompensation of the liver function and hepatocellular carcinoma. Physical activity is widely encouraged in the treatment of various chronic diseases. However, little has been done on the effect of physical activity on the evolutionary course of the HCV-related liver disease. It is known that individuals with chronic hepatitis C may develop other disorders due to physical inactivity that may interfere in the course of the viral disease. Therefore, the objective of the present study was to conduct a literature review on the relationship between physical activity and chronic hepatitis C.