Myopenia and Reduced Subcutaneous Adiposity in Children With Liver Disease Are Associated With Adverse Outcomes.

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Poh Hwa Ooi, Vera C Mazurak, Ravi Bhargava, Abha Dunichand-Hoedl, Rocio Ayala Romero, Susan M Gilmour, Jason Yk Yap, Diana R Mager

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Poh Hwa Ooi: Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
Vera C Mazurak: Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
Ravi Bhargava: Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
Abha Dunichand-Hoedl: Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
Rocio Ayala Romero: Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
Susan M Gilmour: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Jason Yk Yap: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Diana R Mager: Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada. ORCID

PMID: 32710565 DOI: 10.1002/jpen.1963

BACKGROUND: Sarcopenia is defined as reduced skeletal muscle mass (SMM) or myopenia and altered muscle function and physical performance. It is unknown whether myopenia in children with end-stage liver disease (ESLD) adversely impacts clinical outcomes. We hypothesized that myopenia was prevalent in children with ESLD and related to suboptimal nutrition intake contributing to gross motor and growth delay, increased hospitalization, and medical complications.
METHODS: This retrospective study evaluated abdominal imaging (computed tomography/magnetic resonance imaging) for SMM (total, psoas, paraspinal, abdominal wall muscle; cm /height ) and adipose tissue (total, visceral, subcutaneous adipose tissue [SAT], ) determinations at the third and fourth lumbar vertebrates during liver transplantation (LTx) assessment. ESLD children (n = 30) were age- and gender-matched to healthy controls (n = 24). Myopenia was defined as SMM index z score <-2 and low SAT was defined as SAT index z-score <-1.5. Anthropometric, biochemical, and clinical data (hospitalization, complications, growth, neurodevelopment, energy/protein intake) were collected at LTx assessment, LTx, and post LTx (first hospitalization, 6 months, 12 months).
RESULTS: Four distinct body composition phenotypes in children with ESLD were found: (1) myopenia with low SAT (17%;5 of 30), (2) myopenia (3%;1 of 30), (3) low SAT (20%;6 of 30), (4) normal muscle mass and SAT (60%;18 of 30). Myopenia with low SAT was prevalent in older (>2 years), male children and was associated with gross motor delay, reduced energy intake, and increased hospitalization and infections (total/viral/fungal).
CONCLUSIONS: Myopenia, accompanied by low SAT in children with ESLD, is associated with adverse clinical outcomes. Rehabilitation strategies aimed at combating myopenia in children are important.

body fat gross motor delay infection low skeletal muscle mass

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Adiposity

Aged

Child

End Stage Liver Disease

Humans

Intra-Abdominal Fat

Male

Obesity

Retrospective Studies

Sarcopenia

Subcutaneous Fat

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