LOW MUSCLE MASS AND SARCOPENIA IN CIRRHOSIS: PREVALENCE OF LOW PHASE ANGLE AND ASSOCIATIONS WITH NUTRITIONAL VARIABLES

Abstract

Sarcopenia and malnutrition are common in cirrhosis and are associated with adverse outcomes. Bioimpedence analysis (BIA) for skeletal muscle is limited due to fluid accumulation, however low phase angle (PA) is suggestive of low muscle mass in cirrhosis. This study was performed to evaluate the prevalence of sarcopenia (low PA and handrip strength) and low muscle mass (low PA) and its association with clinical/nutritional variables. Patients with cirrhosis (n=41) were grouped into PA ≤4.9° or >4.9°. Sarcopenia was confirmed by PA≤4.9° and handgrip strength (HGS) by dynamometry < 27 and <16 kg in males and females. 20 patients presented PA ≤4.9°. 6 patients were sarcopenic. Compared with higher-PA group, patients with PA≤4.9° were older (p<0.05) and females; presented lower PA (4.2° vs. 5.8°, p <0.0001), HGS (19.7 vs 34.7 kg, p=0.001) and impaired 10-metre walk test (1.4 vs 1.1 m/sec, p=0.001). No differences were detected for BMI, NRS 2002 and SGA scores, plasma albumin and ammonia, Child-Pugh and MELDNa score. In univariate analysis (n=41) PA was positively (p≤0.002) associated with male gender, BIA-measured intracellular water, HGT and albumin and negatively (p<0.015) with walk-test and Child-Pugh score. No correlations were detected with BMI, NRS2002, SGA, BIA-determined total and extracellular water, ammonia, liver enzymes, bilirubin, and MeldNa score. In patients with cirrhosis, the prevalence of low muscle mass is high (up to 50%) and is correlated with functional variables (HGT and walk speed) and disease severity (Child-Pugh score) but not with nutritional scores and BMI. Specific tools are required to identify sarcopenia.