Alcohol-associated Liver Disease Increases the Risk of Muscle Loss and Mortality in Patients with Cirrhosis

Overview

Journal J Gastroenterol

Specialty Gastroenterology

Date 2024 Jul 28

PMID 39068612

Authors

Tatsunori Hanai

Kayoko Nishimura

Shinji Unome

Takao Miwa

Yuki Nakahata

Kenji Imai

Atsushi Suetsugu

Koji Takai

Masahito Shimizu

Affiliations

Soon will be listed here.

Abstract

Background: Rapid skeletal muscle loss adversely affects the clinical outcomes of liver cirrhosis. However, the relationships between the annual changes in skeletal muscle area (ΔSMA/year) and the etiology of cirrhosis, factors associated with muscle loss, and risk of mortality remains unclear.

Methods: A total of 384 patients who underwent multiple computed tomography (CT) scans between March 2004 and June 2021 were enrolled in this study (median age, 67 years; 64% men; median model for end-stage liver disease score, 9). Body composition and ΔSMA/year were estimated using a 3D image analysis system and data from at least two distinct CT scans. Differences in ΔSMA/year among different etiologies of cirrhosis, factors associated with rapid muscle loss (defined as ΔSMA/year ≤ - 3.1%), and the association between ΔSMA/year and mortality were examined.

Results: Patients with alcohol-associated liver disease (ALD) cirrhosis experienced more rapid muscle loss (ΔSMA/year, - 5.7%) than those with hepatitis B (ΔSMA/year, - 2.8%) and hepatitis C cirrhosis (ΔSMA/year, - 3.1%). ALD cirrhosis was independently associated with ΔSMA/year ≤ - 3.1% after adjusting for age, sex, and liver functional reserve. Over a median follow-up period of 3.8 years, ALD cirrhosis, ΔSMA/year ≤ - 3.1%, and low subcutaneous adipose tissue level were found to be significantly associated with reduced survival. ALD cirrhosis (hazard ratio [HR], 2.43; 95% confidence interval [CI] 1.12-5.28) and ΔSMA/year ≤ - 3.1% (HR, 3.68; 95% CI 2.46-5.52) were also predictive of mortality.

Conclusions: These results suggest that ALD cirrhosis increases the risk of rapid muscle loss and mortality in affected patients.

Citing Articles

Impact of Alcohol Intake on Skeletal Muscle: A Large Cross-Sectional Analysis in Japanese Adults.

Matsui M, Fukuda A, Onishi S, Ushiro K, Nishikawa T, Asai A Nutrients. 2025; 17(5).

PMID: 40077764 PMC: 11901683. DOI: 10.3390/nu17050894.

References

Lai J, Tandon P, Bernal W, Tapper E, Ekong U, Dasarathy S . Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021; 74(3):1611-1644. PMC: 9134787. DOI: 10.1002/hep.32049. View

Dasarathy S . Consilience in sarcopenia of cirrhosis. J Cachexia Sarcopenia Muscle. 2012; 3(4):225-37. PMC: 3505573. DOI: 10.1007/s13539-012-0069-3. View

Sarin S, Dhingra N, Bansal A, Malhotra S, Guptan R . Dietary and nutritional abnormalities in alcoholic liver disease: a comparison with chronic alcoholics without liver disease. Am J Gastroenterol. 1997; 92(5):777-83. View

Tantai X, Liu Y, Yeo Y, Praktiknjo M, Mauro E, Hamaguchi Y . Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2021; 76(3):588-599. DOI: 10.1016/j.jhep.2021.11.006. View

Fialla A, Israelsen M, Hamberg O, Krag A, Gluud L . Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta-analysis. Liver Int. 2015; 35(9):2072-8. DOI: 10.1111/liv.12798. View

Hanai T, Shiraki M, Nishimura K, Ohnishi S, Imai K, Suetsugu A . Sarcopenia impairs prognosis of patients with liver cirrhosis. Nutrition. 2014; 31(1):193-9. DOI: 10.1016/j.nut.2014.07.005. View

Kawaguchi T, Izumi N, Charlton M, Sata M . Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology. 2011; 54(3):1063-70. DOI: 10.1002/hep.24412. View

Kawaguchi T, Shiraishi K, Ito T, Suzuki K, Koreeda C, Ohtake T . Branched-chain amino acids prevent hepatocarcinogenesis and prolong survival of patients with cirrhosis. Clin Gastroenterol Hepatol. 2013; 12(6):1012-8.e1. DOI: 10.1016/j.cgh.2013.08.050. View

Kitajima Y, Takahashi H, Akiyama T, Murayama K, Iwane S, Kuwashiro T . Supplementation with branched-chain amino acids ameliorates hypoalbuminemia, prevents sarcopenia, and reduces fat accumulation in the skeletal muscles of patients with liver cirrhosis. J Gastroenterol. 2017; 53(3):427-437. DOI: 10.1007/s00535-017-1370-x. View

10.

Kawaguchi T, Kawaguchi A, Hashida R, Nakano D, Tsutsumi T, Kawaguchi M . Resistance exercise in combination with aerobic exercise reduces the incidence of serious events in patients with liver cirrhosis: a meta-analysis of randomized controlled trials. J Gastroenterol. 2023; 59(3):216-228. DOI: 10.1007/s00535-023-02060-0. View

11.

Tsuchihashi J, Koya S, Hirota K, Koga N, Narao H, Tomita M . Effects of In-Hospital Exercise on Frailty in Patients with Hepatocellular Carcinoma. Cancers (Basel). 2021; 13(2). PMC: 7826707. DOI: 10.3390/cancers13020194. View

12.

Hashida R, Kawaguchi T, Koya S, Hirota K, Goshima N, Yoshiyama T . Impact of cancer rehabilitation on the prognosis of patients with hepatocellular carcinoma. Oncol Lett. 2020; 19(3):2355-2367. PMC: 7039060. DOI: 10.3892/ol.2020.11345. View

13.

Koya S, Kawaguchi T, Hashida R, Goto E, Matsuse H, Saito H . Effects of in-hospital exercise on liver function, physical ability, and muscle mass during treatment of hepatoma in patients with chronic liver disease. Hepatol Res. 2016; 47(3):E22-E34. DOI: 10.1111/hepr.12718. View

14.

Hanai T, Shiraki M, Ohnishi S, Miyazaki T, Ideta T, Kochi T . Rapid skeletal muscle wasting predicts worse survival in patients with liver cirrhosis. Hepatol Res. 2015; 46(8):743-51. DOI: 10.1111/hepr.12616. View

15.

Kim T, Jung Y, Yim H, Baik J, Yim S, Lee Y . Impacts of muscle mass dynamics on prognosis of outpatients with cirrhosis. Clin Mol Hepatol. 2022; 28(4):876-889. PMC: 9597226. DOI: 10.3350/cmh.2022.0231. View

16.

Welch N, Dasarathy J, Runkana A, Penumatsa R, Bellar A, Reen J . Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease. Liver Int. 2020; 40(5):1178-1188. PMC: 7195232. DOI: 10.1111/liv.14358. View

17.

Jeong J, Lim S, Sohn J, Lee J, Won Jun D, Kim Y . Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis. J Korean Med Sci. 2018; 33(50):e299. PMC: 6281953. DOI: 10.3346/jkms.2018.33.e299. View

18.

Tuo S, Yeo Y, Chang R, Wen Z, Ran Q, Yang L . Prevalence of and associated factors for sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis. Clin Nutr. 2023; 43(1):84-94. DOI: 10.1016/j.clnu.2023.11.008. View

19.

DiMartini A, Leggio L, Singal A . Barriers to the management of alcohol use disorder and alcohol-associated liver disease: strategies to implement integrated care models. Lancet Gastroenterol Hepatol. 2022; 7(2):186-195. DOI: 10.1016/S2468-1253(21)00191-6. View

20.

Yoshiji H, Nagoshi S, Akahane T, Asaoka Y, Ueno Y, Ogawa K . Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J Gastroenterol. 2021; 56(7):593-619. PMC: 8280040. DOI: 10.1007/s00535-021-01788-x. View