Thomas Jefferson University Hospital Philadelphia, PA, United States
Gregory Habig, MD1, Christa Smaltz, MD1, Brian Blumhof, MD1, Flavius F. Guglielmo, MD2, Dina Halegoua-DeMarzio, MD2 1Thomas Jefferson University Hospital, Philadelphia, PA; 2Thomas Jefferson University, Philadelphia, PA
Introduction: Sarcopenia, the reduction of muscle mass and function, has been linked to clinical deterioration in cirrhosis. Sarcopenia and non-alcoholic fatty liver disease (NAFLD) have been frequently studied together given the rise in NAFLD and the conditions’ similar pathogenesis. This study aims to compare sarcopenia prevalence in non-alcoholic steatohepatitis (NASH) cirrhosis to other cirrhosis etiologies, and the coincidence of NAFLD risk factors, obesity and type 2 diabetes mellitus (TIIDM). This study hypothesizes that sarcopenia prevalence, and coincident risk factors, is higher in NASH than other cirrhosis causes given their similar pathology.
Methods: Computed tomography and magnetic resonance images were obtained in 101 cases of biopsy proven cirrhosis from NASH, Hepatitis C (HCV), and alcohol (EtOH) from a single center. 32 cases were included based on imaging within 18 months of biopsy. Exclusion was based on biopsy evidence of another etiology of cirrhosis, no cirrhosis, or malignancy. Sarcopenia was defined as a psoas muscle area < 1561 mm2 in men and < 1464 mm2 in women (Figure 1). Statistical analysis included Fisher’s Exact test comparing prevalence.
Results: In the cases of cirrhosis studied, sarcopenia was present in 54.5% (6/11) of NASH, 50% (6/12) of ETOH, 33.3% (4/12) of HCV, and 46.9% (15/32) of cirrhosis regardless of cause. No significant difference in prevalence was detected between etiologies (p=1 NASH and EtOH; p=0.406 NASH and HCV; p=0.660 EtOH and HCV). 82% (9/11) of NASH patients had TIIDM, with sarcopenia in 5/9. 54.5% (6/11) of NASH cases were obese, with sarcopenia in 3/6. 33% (4/12) of EtOH and 12.5% (1/8) of HCV had TIIDM, with concurrent sarcopenia in 50% (3/6) of EtOH and 0 HCV. 33% (4/12) of EtOH and 22% (2/9) of HCV were obese, with concurrent sarcopenia in 16.7% (1/6) EtOH and 0 of HCV.
Discussion: Among etiologies of cirrhosis studied, sarcopenia prevalence appeared similar and relatively high, around 47%. Given poor outcomes previously seen in cirrhosis and sarcopenia and this high observed prevalence, sarcopenia screening should be more commonly performed. Despite more cases of TIIDM and obesity being observed in NASH than the other cirrhosis etiologies, sarcopenia prevalence did not seem to increase when observed together. Further investigation with a larger sample is needed to better characterize sarcopenia prevalence in these conditions and detect significance of any observed trends.
Figure: Computed tomography images of two patients measuring psoas muscle area (PMA) which is defined as the sum of the psoas muscle areas at the L3-L4 level (Glose, 2016). (a) Patient without sarcopenia with PMA highlighted in blue (b) Patient with sarcopenia with PMA highlighted in red.
Disclosures:
Gregory Habig indicated no relevant financial relationships.
Christa Smaltz indicated no relevant financial relationships.
Brian Blumhof indicated no relevant financial relationships.
Flavius Guglielmo indicated no relevant financial relationships.
Dina Halegoua-DeMarzio indicated no relevant financial relationships.
Gregory Habig, MD1, Christa Smaltz, MD1, Brian Blumhof, MD1, Flavius F. Guglielmo, MD2, Dina Halegoua-DeMarzio, MD2. P2832 - The Role of Cirrhosis Etiology on the Prevalence of Sarcopenia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
