The Relationship of Obesity, Nutritional Status and Muscle Wasting in Patients Assessed for Liver Transplantation

Helen Vidot; Katharine Kline; Robert Cheng; Liam Finegan; Amelia Lin; Elise Kempler; Simone  I. Strasser; David  Geoffrey Bowen; Geoffrey  William McCaughan; Sharon Carey; Margaret Allman-Farinelli; Nicholas  Adam Shackel

doi:10.3390/nu11092097

Nutrients (Sep 2019)

The Relationship of Obesity, Nutritional Status and Muscle Wasting in Patients Assessed for Liver Transplantation

Helen Vidot,
Katharine Kline,
Robert Cheng,
Liam Finegan,
Amelia Lin,
Elise Kempler,
Simone I. Strasser,
David Geoffrey Bowen,
Geoffrey William McCaughan,
Sharon Carey,
Margaret Allman-Farinelli,
Nicholas Adam Shackel

Affiliations

Helen Vidot: Department Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, 2050 NSW, Australia
Katharine Kline: Sydney Medical School, The University of Sydney, Sydney, 2006 NSW, Australia
Robert Cheng: Liver Injury and Cancer, Centenary Research Institute, The University of Sydney, Sydney, 2006 NSW, Australia
Liam Finegan: School of Business, The University of Sydney, Sydney, 2006 NSW, Australia
Amelia Lin: Sydney Medical School, The University of Sydney, Sydney, 2006 NSW, Australia
Elise Kempler: Sydney Medical School, The University of Sydney, Sydney, 2006 NSW, Australia
Simone I. Strasser: Sydney Medical School, The University of Sydney, Sydney, 2006 NSW, Australia
David Geoffrey Bowen: Liver Injury and Cancer, Centenary Research Institute, The University of Sydney, Sydney, 2006 NSW, Australia
Geoffrey William McCaughan: Liver Injury and Cancer, Centenary Research Institute, The University of Sydney, Sydney, 2006 NSW, Australia
Sharon Carey: Department Nutrition & Dietetics, Royal Prince Alfred Hospital, Camperdown, 2050 NSW, Australia
Margaret Allman-Farinelli: School of Life and Environmental Sciences Charles Perkins Centre, The University of Sydney, Sydney, 2006 NSW, Australia
Nicholas Adam Shackel: Liver Injury and Cancer, Centenary Research Institute, The University of Sydney, Sydney, 2006 NSW, Australia

DOI: https://doi.org/10.3390/nu11092097
Journal volume & issue: Vol. 11, no. 9
p. 2097

Abstract

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Introduction: Obesity co-exists with malnutrition and muscle atrophy in patients with cirrhosis. Muscle wasting is a feature of sarcopenia, a known determinant of patient outcomes. This is the first description of a relationship between obesity, subjective global assessment (SGA) of nutritional status and muscle wasting in patients with cirrhosis. Methods: The relationship between body mass index (BMI with obesity defined as ≥ 30 kg/m2), nutritional status (assessed by liver-specific subjective global assessment—SGA) and muscle wasting (assessed by corrected total cross-sectional psoas muscle area—cTPA) was analysed in patients with cirrhosis considered for liver transplantation between 1 January 2012 and 31 December 2014. Results: There were 205 patients, of whom 70% were males. The mean age was 52 ± 0.7 years and the Model for End-Stage Liver Disease (MELD) score was 16.8 ± 0.5. Overall, 31% of patients were obese and 56% of well-nourished (SGA A) individuals were obese. Muscle wasting was identified in 86% of all patients, irrespective of their nutritional status (A, B, C). All obese males classified as well-nourished (SGA A) were sarcopenic and 62% of obese females classified as SGA A were sarcopenic. Muscle wasting was worse in obese individuals (cTPA 230.9 mm2/m2 ± 12.9, p < 0.0001) and more likely to be associated with hepatic encephalopathy (p = 0.03). Univariate and multivariate analysis demonstrated testosterone deficiency was significantly associated with muscle wasting (p = 0.007) but not obesity (p = 0.8). Conclusion: Obesity combined with muscle wasting is common in patients with cirrhosis. Muscle wasting is common in well-nourished (SGA A) obese patients. Consequently, all patients assessed for liver transplantation should undergo additional screening for malnutrition and muscle wasting irrespective of BMI.

Published in Nutrients

ISSN: 2072-6643 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Technology: Home economics: Nutrition. Foods and food supply
Website: https://www.mdpi.com/journal/nutrients

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