Mid-arm Muscle Circumference Research Articles

Assessing the risk factors associated with nutritional status in patients with liver cirrhosis: A case-control study.

Cirrhosis is one of the most common clinical diseases in the world. The patient with cirrhosis has many complications, such as spontaneous peritonitis, hepatic encephalopathy. Malnutrition is one of the most common complications in patients with cirrhosis, and it is also a key factor affecting the prognosis of patients. However, the research on cirrhosis malnutrition is relatively scarce. This study aimed to explore the new factors of the liver cirrhosis with the nutritional status. A total of 370 patients with liver cirrhosis were admitted to the Fourth Affiliated Hospital of Harbin Medical University from January 2019 to January 2023 were selected. Patients were assigned to the malnourished group and normal group. The weight, height, mid arm circumference (MAC) and triceps skinfold thickness (TSF) of the two groups were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Furthermore, the Health Literacy Management Scale (HeLMS), biochemical indexes, incidence of complications, disease grade were also counted and the Royal Free Hospital-Nutrition Prioritization Tool were used to evaluate the nutritional status of the patient. A total of 370 patients was included in this study, including 177 malnutrition patients, accounting for 45.29%, and the scores and total scores of the patients in the malnutrition group were lower than those in the normal group. The measured values of Na+, Alb, PA, T-Bil, TC, TLC, Hb, and RBC were all lower than those of the normal group, and the difference was statistically significant. The overall complication rate of the patients in the malnourished group was 89.61%, and that of the normal group was 39.78%. Multifactorial logistic regression analysis was performed with nutritional level as the dependent variable (normal = 0, malnutrition = 1), and the above indicators of variability (Na+, Alb, PA, T-Bil, TC, PT, Hb, RBC, HG, and HeLMS scores) as the independent variables. The results showed that Na+, Hb were the influencing factors of nutritional level (P< 0.05). The incidence of malnutrition in cirrhotic patients included in this study was at a moderate level, and the nutritional literacy of these patients was low. In addition, the level of serum sodium, Hemoglobin can affect the nutritional level of patients with cirrhosis.

Sodium Bicarbonate Treatment and Clinical Outcomes in Chronic Kidney Disease with Metabolic Acidosis: A Meta-Analysis.

In patients with chronic kidney disease (CKD), impaired kidney acid excretion leads to the onset of metabolic acidosis (MA). However, the evidence is not yet conclusive regarding the effects of sodium bicarbonate in treating CKD with MA. Databases with PubMed, Embase, and the Cochrane Library were used to search for randomized controlled trials from the inception until November 11, 2023 to identify randomized controlled trials investigating the effect of sodium bicarbonate in participants with CKD and MA. The primary outcome was the change in estimated glomerular filtration rate (eGFR). Secondary outcomes included hospitalization rates, change in systolic blood pressure (SBP), all-cause mortality, and mid-arm muscle circumference (MAMC). A random-effects model was applied for analysis, and subgroup, sensitivity analyses were also performed. Fourteen RCTs comprising 2,037 patients demonstrated that sodium bicarbonate supplementation significantly improved eGFR (standardized mean difference [SMD]: 0.33, 95% CI: 0.03 to 0.63, P = 0.03). The group receiving sodium bicarbonate had a lower hospitalization rate (odds ratio: 0.37, 95% CI: 0.25 to 0.55, P < 0.001). Higher MAMC was observed with sodium bicarbonate treatment compared with those without (SMD:0.23, 95% CI: 0.08 to 0.38, P = 0.003, I2 < 0.001). However, higher risk of elevated SBP was found with sodium bicarbonate treatment (SMD:0.10, 95% CI: 0.01 to 0.20, P = 0.03). No significant difference in all-cause mortality was noted. In patients with CKD and MA, sodium bicarbonate supplementation may provide potential benefits in preventing the deterioration of kidney function and increasing muscle mass. However, treatment may be associated with higher blood pressure. Due to the risk of bias stemming from the absence of double-blinded designs and inconsistencies in control group definitions across the studies, further research is crucial to verify these findings.

Effectiveness of Nutritional Supplementation in Liver Transplant Recipients during Early Postoperative Course: A Systematic Review and Meta-Analysis

Abstract Background Nutrition is an integral part of health maintenance. The liver is the largest and most important metabolic organ, playing a pivotal role in integrating several biochemical pathways of carbohydrate, fat, protein, and vitamin metabolism. Malnutrition is a common complication of end- stage liver disease (ESLD). Progressive deterioration of nutritional status has been associated with poor outcome in cirrhotic patients. Liver transplantation (LT) revolutionized the management of liver disease. Nutritional therapy is an integral part of liver transplant care. Objective To identity the efficacy of different dietary nutritional supplements as zinc, vit D and immunonutrients (glutamine, omega 3, arginine and ribonucleic acid) for recipient at early post operative course. Material and Methods In this systematic review and meta-analysis we enrolled a total of 7 studies for assessing the clinical outcomes of ICU patients underwent liver transplantation surgery and supplied with dietary supplements during early postoperative period. The studies also assessed the laboratory assessment of patients postoperatively during ICU admission period. Results Regarding postoperative dietary supplementations with HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB. Also we did not find significant difference between base line and postoperative in both groups for Mid-arm muscle-circumference (MAMC), Fat mass index (FMI), 6-minute walk test (6MWT), and Handgrip (HG). Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Conclusion BCAA as dietary supplementation showing a significant favorable effect regarding the baseline and the postoperative BTR levels, also for BCAA levels, Tyrosine levels, prealbumin levels, retinol binding protein and PTINR levels in both intervention and control groups. For HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB.

The predictive value of GLIM criteria on clinical outcomes and responses to nutritional support in patients with neurocritical illnesses

Neurocritically ill patients frequently exhibit coma, gastroparesis, and intense catabolism, leading to an increased risk of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition was created to achieve a consistent malnutrition diagnosis across diverse populations. This study aimed to validate the concurrent and predictive validity of GLIM criteria in patients with neurocritical illnesses. A total of 135 participants were followed from admission to the neurocritical unit (NCU) until discharge. Comparing GLIM criteria to the Subjective Global Assessment (SGA), sensitivity was 0.95 and specificity was 0.69. Predictive validity of GLIM criteria was assessed using a composite adverse clinical outcome, comprising mortality and various major complications. Adjusted hazard ratios for moderate and severe malnutrition were 2.86 (95% CI 1.45–5.67) and 3.88 (95% CI 1.51–9.94), respectively. Changes in indicators of nutritional status, including skeletal muscle mass and abdominal fat mass, within 7 days of admission were obtained for 61 participants to validate the predictive capability of the GLIM criteria for the patients’ response of standardized nutritional support. The GLIM criteria have a statistically significant predictive validity on changes in rectus femoris muscle thickness and midarm muscle circumference. In conclusion, the GLIM criteria demonstrate high sensitivity for diagnosing malnutrition in neurocritically ill patients and exhibit good predictive validity.

Performance of anthropometry-based and bio-electrical impedance-based muscle-mass indicators in the Global Leadership Initiative on Malnutrition criteria for predicting prognosis in patients with cancer

BackgroundReduced muscle mass is a criterion for diagnosing malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria; however, the choice of muscle-mass indicators within the GLIM criteria remains contentious. This study aimed to establish muscle-measurement-based GLIM criteria using data from bio-electrical impedance analysis (BIA) and anthropometric evaluations and evaluate their ability to predict overall survival (OS), short-term outcomes, and healthcare burden in patients with cancer. MethodsThis was a multicenter, prospective study that commenced in 2013 and enrolled participants from various clinical centers across China. We constructed GLIM criteria based on various muscle measurements, including fat-free mass index (FFMI), skeletal muscle index (SMI), calf circumference (CC), midarm circumference (MAC), midarm muscle circumference (MAMC), and midarm muscle area (MAMA). Survival was estimated using the Kaplan-Meier method and survival curves were compared using the log-rank test. Cox proportional hazards regression was used to assess the independent association between the GLIM criteria and OS. The discriminatory performance of different muscle-measurement-based GLIM criteria for mortality was evaluated using Harrell's concordance index (C-index). Logistic regression was used to evaluate the association of the GLIM criteria with short-term outcomes and healthcare burden. ResultsA total of 4,769 patients were included in the analysis, of whom 1,659 (34.8%) died during the study period. The Kaplan-Meier curves demonstrated that all muscle-measurement-based GLIM criteria significantly predicted survival in patients with cancer (all p<0.001). The survival rate of malnourished patients was approximately 10% lower than that of non-malnourished patients. Cox proportional hazards regression showed that all the muscle-measurement-based GLIM could independently predict the OS of patients (all p<0.001). The prognostic discrimination was as follows: MAMC (Chi-square: 79.61) > MAMA (Chi-square: 79.10) > MAC (Chi-square: 64.09) > FFMI (Chi-square: 62.33) > CC (Chi-square: 58.62) > ASMI (Chi-square: 57.29). In comparison to the FFMI-based GLIM criteria, the ASMI-based criteria (-0.002, 95% CI: -0.006-0.002, p=0.334) and CC-based criteria (-0.003, 95% CI: -0.007-0.002, p=0.227) did not exhibit a significant advantage. However, the MAC-based criteria (0.001, 95% CI: -0.003-0.004, p=0.776), MAMA-based criteria (0.004, 95% CI: 0.000-0.007, p=0.035), and MAMC-based criteria (0.005, 95% CI: 0.000-0.007, p=0.030) outperformed the FFMI-based GLIM criteria. Logistic regression showed that muscle measurement-based GLIM criteria predicted short-term outcomes and length of hospital stay in patients with cancer. ConclusionAll muscle measurement-based GLIM criteria can effectively predict OS, short-term outcomes, and healthcare burden in patients with cancer. Anthropometric measurement-based GLIM criteria have potential for clinical application as an alternative to BIA-based measurement.

#1519 Nutritional impact of ketoanalogue supplementation with protein-restricted diets in advanced chronic kidney disease

Abstract Background and Aims The benefits and risks of a protein-restricted diet supplemented with ketoanalogues (KA) in patients with chronic kidney disease (CKD) are still being explored. Combining KA supplementation with a protein-restricted diet may potentially preserve the glomerular filtration rate (GFR) in CKD patients. However, concerns about protein-energy wasting and the nutritional benefits of KA supplementation remain uncertain. Previous systematic reviews have often included crossover or non-randomized studies and combined data from CKD and dialysis patients, potentially introducing heterogeneity when assessing the effects of KA supplementation in CKD patients. We aim to provide an updated and comprehensive assessment of the impact of combining KA supplementation with a protein-restricted diet on the nutritional status of advanced CKD patients compared to the effects of a protein-restricted diet alone. Method We conducted systematic literature searches of PubMed, Embase, Scopus, and Cochrane Library up to September 2023. We selected parallel-design randomized controlled trials comparing KA supplementation to a low- or very low-protein diet (VLPD) versus a low-protein diet (LPD) alone in adults with stages 3-5 CKD. Outcomes included serum albumin, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC). Pooled estimates of effect measures were calculated using the random-effects model and presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Given the variation in CKD stages among the included studies, subgroup analyses were conducted based on baseline renal function (GFR &amp;lt; 20 vs. ≥ 20 mL/min/1.73 m²). To assess the robustness of our meta-analyses, we conducted sensitivity analyses by excluding studies with an in-trial follow-up duration of less than one year. Results We identified 13 trials with 974 participants and a median follow-up of 12 months. KA supplementation combined with an LPD or a VLPD significantly increased TSF compared to an LPD alone (SMD, 0.25; 95% CI, 0.04, 0.45; P = 0.02; Fig. 1). No significant differences were observed in serum albumin (SMD, 0.28; 95% CI, -0.05, 0.61; P = 0.10; Fig.) and MAMC (SMD, 0.10; 95% CI, -0.12, 0.32; P = 0.37; Fig. 1). KA supplementation significantly increased serum albumin in patients with a baseline GFR ≥ 20 mL/min/1.73 m² (SMD 0.52; 95% CI, 0.20, 0.84; P = 0.001), but not in those with a baseline GFR &amp;lt; 20 mL/min/1.73 m² (SMD, -0.04; 95% CI, -0.41, 0.34; P = 0.85), and this difference between the subgroups was statistically significant (P = 0.03; Fig. 2). Sensitivity analysis that excluded studies with an in-trial follow-up duration of less than one year yielded results similar to the main analysis, except that the difference in TSF between the intervention and control arms became nonsignificant. Conclusion In patients with stages 3-5 CKD, KA supplementation with a protein-restricted diet did not adversely affect nutritional status. These findings remained consistent in sensitivity analyses of RCTs with a follow-up of more than one year and in subgroup analyses based on baseline GFR. The addition of KAs to protein-restricted diets improved serum albumin levels in patients with a baseline GFR of ≥ 20 mL/min/1.73 m². Our analyses confirmed the efficacy and safety of KA supplementation on nutritional status in advanced CKD patients over a one year follow-up period.

Mid-arm muscle circumference cutoff points in patients with cirrhosis: Low muscle mass related to malnutrition predicts mortality

ObjectivesMuscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality. MethodsThis is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality. ResultsWe included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24–2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85–0.94, P < 0.001). ConclusionsLow MAMC classified according to the new cutoff points predicts mortality risk in patients with cirrhosis and could be used in clinical practice.

Association of handgrip strength with nutritional status and clinical outcomes in hospitalized pediatric patients

Background & aimsMalnutrition in children and adolescents is prevalent at hospital admission and the incidence increases with length of stay. Malnourished patients have loss of muscle mass and strength, compromising their functionality. Handgrip strength (HGS) is a nutritional marker understudied in pediatrics although it is capable of detecting nutritional deprivation before changes in body composition are observed. Therefore, this study aimed to evaluate the association between reduced HGS at hospital admission, compromised nutritional status and worse clinical outcomes of pediatric patients. MethodsCohort study conducted with patients aged 6 to 18 years admitted to a pediatric ward. Nutritional status was assessed in the first 48 hours of hospital admission using the z-score of height for age (H/A) and body mass index for age (BMI/A), percentile of mid-arm muscle circumference for age (MAMC/I) and the pediatric global subjective nutritional assessment (SGNA). HGS was measured using a digital dynamometer and considered reduced when the maximum value of three measurements was below the 5th percentile for sex and age. The clinical outcomes analyzed were length of hospital stay and frequency of readmission within 3 months after hospital discharge. ResultsA total of 135 patients were evaluated (median age 10.9 years, 55.6% male) and 17.8% had reduced HGS. Patients with reduced HGS had lower H/A z-score (-0.50 vs 0.22, p = 0.012) and a higher frequency of reduced MAMC when compared to those with normal HGS (8% vs 13%, p = 0.007). Reduced HGS was not associated with malnutrition (OR=0.63; 95%CI 0.23 - 1.77), prolonged hospital stay (OR=1.89; 95%CI 0.72 - 4.92) or readmission to hospital 3 months after hospital discharge (OR=1.82; 95%CI 0.67 - 4.93), in a model adjusted for the clinical condition. ConclusionReduced HGS was not a predictor of malnutrition and clinical outcomes. However, it was associated with lower H/A Z-score and MAMC/A percentile values and can be used as a complementary measure in the nutritional status assessment of hospitalized pediatric patients.

Nutrition status and incidence of malnutrition in home enteral nutrition patients: A cross sectional study

Home enteral nutrition (HEN) is a long-term, life-sustaining nutrition therapy for patients unable to consume sufficient food orally. Patients rely on a prescribed, manufactured product to provide their full nutrient requirements, although some patients may have supplementary oral intake. Prescribed enteral nutrition is used as a treatment for malnutrition, but may, in the long-term, cause poor nutrition status. This study aimed to investigate the nutrition status (energy, protein, vitamin D, and selenium) and malnutrition incidence in long-term HEN patients in the Counties Manukau region. In this cross-sectional study, 42 adults on HEN for 4+ weeks under the care of Te Whatu Ora Health New Zealand were analysed. Participants’ enteral and oral feeding regimes were tracked using patient records and five non-consecutive 24-hour recalls. Biochemical markers, body mass index (BMI), body composition (BIA), and nutrition focussed physical findings were evaluated using reference standards and the Global Leadership Initiative on Malnutrition (GLIM) malnutrition criteria(1). Independent t-tests and Mann-Whitney tests compared participants based on their enteral and supplementary oral intakes and adherence to their enteral prescription. Dependent t-tests and Wilcoxon tests evaluated nutrients contributions from various feeding methods and sources. Over half (54.7%, n = 23) relied exclusively on enteral nutrition, but 60% did not achieve their full energy prescription. Compared to requirements based on the Oxford equation and 1g/kg of body weight, energy and protein intake was low in 20% of all participants, mean intake of these participants was 1,242 ± 183 kcal and 57.5 ± 13.5 g respectively. Participants with full enteral intake had a significantly higher vitamin D intake (14.9 µg, P&lt;0.05) than those with supplementary oral intake (11.2 µg, P&lt;0.05). However, those with oral intake had significantly higher intake of selenium, energy, and all the macronutrients than those with sole enteral intake. Vitamin D and selenium intakes were significantly greater in participants obtaining their full prescription than those that did not. No participants had low vitamin D or selenium blood concentrations, however 40% and 38.1% respectively were high. There was a significant relationship between meeting their energy prescription and high plasma selenium. Low BMI, mid arm muscle circumference, and fat free mass index were observed in 47.5%, 40.5%, and 44.8% of participants respectively. This was not statistically significant between groups. Fat mass and waist circumference were significantly higher in participants on full enteral nutrition. According to the GLIM malnutrition criteria, 62.5% (n = 25) of all participants were malnourished. In conclusion, while HEN patients maintain good vitamin D and selenium status, energy and protein malnutrition are evident. The types of food consumed by those with oral intake may be responsible for the differences in nutritional status. Further attention to prescription adherence and nutritional balance from HEN and oral intake is necessary for this vulnerable group.

Effectiveness of different tools for malnutrition in the assessment of patients with cirrhosis

BackgroundWe aimed to evaluate the prevalence of malnutrition using traditional measures of nutritional assessments like body mass index (BMI), mid-arm circumference (MAC), triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), hand grip strength (HGS) and subjective global assessments (SGA) among cirrhotic patients referred for liver transplantation (LT). MethodsThe study was conducted among 215 cirrhotic patients referred for LT at a tertiary care hospital. Patients were enrolled between July 2021 and October 2022 to assess the prevalence of malnutrition. Patient's demographic details, clinical history, BMI using dry weight, MAMC, HGS, SGA score and disease severity were assessed. ResultsChronic alcoholism was the main causative factor for cirrhosis, followed by viral infection. 58% of cirrhotic patients were moderately to severely malnourished based on SGA, 12% were undernourished based on BMI, 91% had low MAC, and 94% had low HGS/muscle strength indicating malnutrition. Low MAC (p = 0.048) and SGA (p = 0.000) were associated with CTP – B and C class, and low MAC (p = 0.046), low TSF (p = 0.005), and SGA (p = 0.000), were associated with MELD Na score >15. Low MAC (p = 0.011) and SGA (P = 0.000) were associated with mortality, although 78% of patients had MAC within the normal range. A strong association exists between malnutrition and complications, liver disease severity, and death. ConclusionIn patients with chronic liver diseases, SGA performed well as a good predictor of malnutrition, this might be because SGA analyzes various domains which can be affected in chronic liver disease. Assessing malnutrition early may help in initiating appropriate medical nutritional therapy.

SARC-F Score: A Quick Bedside Tool to Screen Sarcopenia in Patients With Cirrhosis

Sarcopenia is often ignored in clinical practice despite being an important prognostic marker. SARC-F is a simple bedside score to assess muscle abnormalities in cirrhosis patients. However, there is limited Indian data on the validity of this score. Hence, we aimed to assess the validity of SARC-F score in a tertiary care center. A prospective observational study including consecutive 100 cirrhosis patients attending the gastroenterology outpatient department in Osmania Medical College and Hospital, Hyderabad, India, was conducted from Jan 2018 to Dec 2019. The primary aim was to assess the mean muscle volume loss (MVL) by computed tomography and handgrip (HG) strength for muscle strength decline (MSD) and compare the SARC-F score with standard cut-off values. We included 100 cirrhosis patients (mean age: 45 years; males: 86%; child-pugh class B/C: 42/58). Sixty-nine percent of the patients had a SARC-F score of ≥4, whereas MVL and MSD were noted in 62% and 86% patients, respectively. Mid-arm circumference, skin-fold thickness, mid-arm muscle circumference (MAMC), and HG strength were significantly lower in patients with SARC-F score ≥4 than in those with SARC-F score <4 (P<0.05). The Pearson correlation plot suggested a significant inverse correlation between the SARC-F score and MSD and SARC-F score and MVL. A SARC-F score of ≥4 had a sensitivity and specificity of 80.7% and 50% for MVL and 75.6% and 71.4% for MSD, respectively, whereas it was 83.3% and 52.5% for MSD and MVL combined, respectively. Area under the receiver operating characteristic curve for SARC-F as a predictor of MVL was 0.75 (95% confidence interval: 0.64-0.82; P=<0.001). On multivariate analysis, a high SARC-F score and low MAMC were predictive of MVL in cirrhosis patients. SARC-F score has good sensitivity as a bedside screening tool for sarcopenia in patients with cirrhosis. A high SARC-F score and low MAMC indicates the presence of MVL and warrants further evaluation for sarcopenia.

Myosteatosis for Early Detection of Muscle Disorder in Patients With Liver Cirrhosis

Background and AimsMuscle disorders in cirrhosis is associated with poor outcome and needs early identification. Anthropometric measures lack sensitivity, and CT-based L3-skeletal muscle Index(L3-SMI) may miss early sarcopenia. The study aimed to find if SM-RA can identify more patients with muscle disorder than L3-SMI and anthropometry. Methods388 patients with cirrhosis underwent nutritional assessment by anthropometry, short-physical-performance-battery (SPPB) <9, L3-SMI (<36.5 cm2/m2 (males); <30.2 cm2/m2 (females), and myosteatosis assessment by skeletal muscle radiation attenuation (SM-RA)(<41 HU for body mass index [BMI] <24.9 kg8m2 and <33 HU for ≥25 kg/m2) and results were compared. ResultsSarcopenia based on SPPB was 38.9% with scores (9 ±1.48 vs. 10.74 ±1.25, p=0.001 in males; and 8.43 ±1.59 vs. 9.89 ±1.57, p=0.001in females). Mid-arm muscle circumference was lower in sarcopenic males [20.5 ±2.42 vs. 22.9 ±2.19 cm, p=0.001] but not in females [19.4 ± 2.73 vs. 21.1 ± 2.51, p =0.18]. L3-SMI-based sarcopenia was found in 44.8% (additional 5.92%) compared to SPPB, mostly in cryptogenic cirrhosis (19.2% vs. 35.08%, δ change +15.9%). Myosteatosis (71.64%) identified an additional 26.85% and 32.74% of patients with muscle disorder compared to L3SMI and SPPB, respectively, with the majority of new detection in non-alcoholic fatty liver disease (NAFLD) 39.4% vs. 77.06%, δ change +37.66%) CTP-A patients (16.6% vs. 36.8%, δ change +20.2%). Myosteatosis was found in 48.3% of patients with normal L3-SMI. ConclusionSM-RA can identify more patients with muscle-disorder than L3-SMI and SPPB.

Association Between Mid-arm Muscle Circumference and Cognitive Function: A Longitudinal Study of Chinese Adults.

Dementia affects 55 million people worldwide and low muscle mass may be associated with cognitive decline. Mid-arm muscle circumference (MAMC) correlates with dual-energy Xray absorptiometry and bioelectrical impedance analyses, yet are not routinely available. Therefore, we examined the association between MAMC and cognitive performance in older adults. We included community-dwelling adults ≥55years from the China Health and Nutrition Survey. Cognitive function was estimated based on a subset of the modified Telephone Interview for Cognitive Status (0-27, low-high) during years (1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, 2018). A multivariable linear mixed-effects model was used to test whether MAMC was associated with rate of cognitive decline across age groups and cognitive function overall. Of 3702 adults (53% female, 63.2 ± 7.3years), mean MAMC was 21.4cm ± 3.0 and baseline cognitive score was 13.6 points ±6.6. We found no evidence that the age-related rate of cognitive decline differed by MAMC (P = .77). Declines between 5-year age groups ranged from -.80 [SE (standard error) .18] to -1.09 [.22] for those at a mean MAMC, as compared to -.86 [.25] to -1.24 [.31] for those at a 1 MAMC 1 standard deviation above the mean. Higher MAMC was associated with better cognitive function with .13 [.06] higher scores for each corresponding 1 standard deviation increase in MAMC across all ages. Higher MAMC at any age was associated with better cognitive performance in older adults. Understanding the relationship between muscle mass and cognition may identify at-risk subgroups needing targeted interventions to preserve cognition.

Mid-arm muscle circumference and triceps skinfold thickness associated with cardiometabolic disease in Chinese residents: A prospective cohort study

Background and aimsThe association of cardiometabolic disease (CMD) with body muscle and fat mass remains unclear. Mid-arm muscle circumference (MAMC) and triceps skinfold (TSF) thickness are easily obtained measuring methods for these two body compositions. This study aimed to investigate the association of CMD with MAMC and TSF thickness among Chinese residents. MethodsA total of 9440 eligible participants from the China Health and Nutrition Survey were included in the analysis. Associations of CMD prevalence with MAMC and TSF thickness were estimated using logistic regression models. Multivariable COX proportional-hazards regression models were used to estimate the effect of baseline MAMC and TSF thickness on subsequent CMD. ResultsPositive associations of CMD prevalence with MAMC (odds ratio [OR] = 1.169, 95% confidence interval [CI] 1.110-1.232, P < 0.001) and TSF thickness (OR = 1.313, 95%CI 1.240-1.390, P < 0.001) were observed in the cross-sectional analysis. In the longitudinal study, a 1-SD increase in MAMC was associated with a 13.6% increased risk of CMD incidence (hazard ratio [HR] = 1.136, 95%CI 1.073-1.204, P < 0.001), and a 1-SD increase in TSF thickness had a 17.6% increased risk of CMD incidence (HR = 1.176, 95%CI 1.084-1.276, P < 0.001). For the CMD components, both MAMC and TSF thickness contributed to increased incidences of hypertension (HR = 1.163, 95%CI 1.097-1.233, P < 0.001 in MAMC; HR = 1.218, 95%CI 1.110-1.336, P < 0.001 in TSF thickness) and diabetes mellitus (HR = 1.166, 95%CI 1.028-1.323, P = 0.017 in MAMC; HR = 1.352, 95%CI 1.098-1.664, P = 0.004 in TSF thickness). ConclusionsIndividuals with higher MAMC and TSF thickness had an increased incidence of CMD, mainly hypertension and diabetes mellitus. This study revealed a seemingly counterintuitive association between body muscle mass and metabolic homeostasis. Although the potential mechanisms require further exploration, the impact of body muscle mass on metabolic health cannot be ignored.

Effects of correcting metabolic acidosis on muscle mass and functionality in chronic kidney disease: a systematic review and meta-analysis.

Metabolic acidosis unfavourably influences the nutritional status of patients with non-dialysis dependent chronic kidney disease (CKD) including the loss of muscle mass and functionality, but the benefits of correction are uncertain. We investigated the effects of correcting metabolic acidosis on nutritional status in patients with CKD in a systematic review and meta-analysis. A search was conducted in MEDLINE and the Cochrane Library from inception to June 2023. Study selection, bias assessment, and data extraction were independently performed by two reviewers. The Cochrane risk of bias tool was used to assess the quality of individual studies. We applied random effects meta-analysis to obtain pooled standardized mean difference (SMD) and 95% confidence intervals (CIs). We retrieved data from 12 intervention studies including 1995 patients, with a mean age of 63.7±11.7years, a mean estimated glomerular filtration rate of 29.8±8.8mL/min per 1.73m2 , and 58% were male. Eleven studies performed an intervention with oral sodium bicarbonate compared with either placebo or with standard care and one study compared veverimer, an oral HCl-binding polymer, with placebo. The mean change in serum bicarbonate was +3.6mEq/L in the intervention group and +0.4mEq/L in the control group. Correcting metabolic acidosis significantly improved muscle mass assessed by mid-arm muscle circumference (SMD 0.35 [95% CI 0.16 to 0.54], P<0.001) and functionality assessed with the sit-to-stand test (SMD -0.31 [95% CI -0.52 to 0.11], P=0.003). We found no statistically significant effects on dietary protein intake, handgrip strength, serum albumin and prealbumin concentrations, and blood urea nitrogen. Correcting metabolic acidosis in patients with CKD improves muscle mass and physical function. Correction of metabolic acidosis should be considered as part of the nutritional care for patients with CKD.

The effects of oral sodium bicarbonate supplementation on anthropometric measures in patients with chronic kidney disease: A systematic review and meta-analysis of randomized clinical trials.

Metabolic acidosis (MA) may play a key role in the pathogenesis of protein-energy wasting (PEW) in patients with chronic kidney disease (CKD). To present a comprehensive synthesis of the effect of oral sodium bicarbonate (SB) supplementation on anthropometric measures in patients with CKD, a systematic review was undertaken in PubMed/MEDLINE, Web of Science, Cochrane CENTRAL, and Google Scholar, of relevant articles published prior to September 2022. The summary statistics of effect size, nonstandardized weighted mean difference (WMD), and 95% confidence interval (CI) were used to compare the effects of SB supplementation on anthropometric parameters vs. control group. To detect probable sources of heterogeneity, a series of predefined subgroup analyses were conducted. In total, 17 studies with 21 treatment arms, including 2203 participants (1149 cases, 1054 controls), met our inclusion criteria and were included in the meta-analysis. SB supplementation had no significant effect on body weight (BW), midarm muscle circumference (MAMC), or lean body mass (LBM) in patients with CKD. There was a significant increase in body mass index (BMI) (MD: 0.59 kg/m2, 95% CI: 0.25 to 0.93, p = 0.001) after SB supplementation in the overall analysis. In subgroup analysis, LBM was increased in studies that were ≥ 24-week duration (MD: 1.81 kg, 95% CI: 0.81 to 2.81) and in participants with BMI lower than 27 kg/m2 (MD: 1.81 mg/L, 95% CI: 0.81 to 2.81). SB supplementation may yield increases in BMI in predialysis CKD patients. However, our findings did not support the beneficial effects of SB supplementation on other anthropometric outcomes. There is an evident need for long-term high-quality interventions to confirm these findings.

Could cooling dialysate improve inflammatory and nutritional status of hemodialysis patients?

BackgroundIt has been shown that dialysate cooling (lowering the dialysate temperature to 0.5 °C below central body temperature) reduces the incidence of intradialytic hypotension. Other influences on hemodialysis patients, however, have not been adequately investigated. The purpose of this study was to determine the impact of individualized dialysate cooling on nutritional and inflammatory parameters in chronic hemodialysis (HD) patients.MethodsSeventy HD patients were separated into two groups: group A: (control group) standard dialysate temperature was 37 °C, and group B: (intervention group) dialysate temperature was 0.5 °C below core body temperature. In addition to routine laboratory tests, blood pressure, anthropometric measurements, inflammatory markers, and the malnutrition inflammation score (MIS) were calculated.ResultsAfter six months of dialysate cooling, intradialytic hypotension episodes were much less prevalent in the intervention group (p = 0.001). Serum ferritin, transferrin saturation (TSAT), high sensitive C-reactive protein (HS-CRP), and Interleukin-6 (IL-6) reduced following dialysate cooling, whereas serum albumin rose. In the control group, IL-6 dropped but serum ferritin, TSAT, albumin, and HS-CRP rose. In both groups, hemoglobin levels dropped, and erythrocyte sedimentation rate (ESR) rose, both groups’ midarm muscle circumference and MIS worsened.ConclusionCold dialysate decreased intradialytic hypotension with no significant improvement of the nutritional and inflammatory surrogates. However, more studies including larger number of patients with longer duration of follow up are required to adequately assess its effect on inflammation and nutrition in chronic hemodialysis patients.

The association between muscle mass indices, irisin and arterial stiffness in postmenopausal women

Introduction: The prevalence of sarcopenia differs per age group and gender. Non-invasive muscle mass indices like mid-upper arm circumference (MUAC) and mid-arm muscle circumference (MAMC) have been considered indicators of sarcopenia and predictors of overall mortality. Cross-talk between fat and muscle tissue is likely to be facilitated by myokines, like irisin, which is also implicated in vascular reactivity. We aimed to assess the association between MAMC, MUAC triceps skinfold (TSF) with irisin, and arterial stiffness in a sample of postmenopausal women.

Effects of anthropometric changes on hospitalization and mortality among patients on hemodialysis.

Low values for anthropometric indicators are risk factors for adverse clinical outcomes among patients on hemodialysis. Nonetheless, little is known about the association between the trajectory of anthropometric indicators and prognosis. We examined theassociation between a one-year change in anthropometric indicators and hospitalization and mortality in patients undergoing hemodialysis. This retrospective cohort study collected data on five anthropometric indicators from patients undergoing maintenance hemodialysis: body mass index, mid-upper arm circumference, triceps skinfold, mid-arm muscle circumference, and calf circumference. We calculated their trajectories over one year. The outcomes were all-cause death and the number of all-cause hospitalizations. Negative binomial regressions were used to examine these associations. We included 283 patients (mean age, 67.3years; 60.4% males). During the follow-up period (median, 2.7years), 30 deaths and 200 hospitalizations occurred. Body mass index (incident rate ratio [IRR]: 0.87; 95% confidence interval [CI] 0.85-0.90), mid-upper arm circumference (IRR: 0.94; 95% CI 0.88-0.99), triceps skinfold (IRR: 0.92; 95% CI 0.84-0.99), and mid-arm muscle circumference (IRR: 0.99; 95% CI 0.98-0.99) increases over one year were associated with a lower risk of all-cause hospitalizations and death regardless of their value at any one point in time. However, the calf circumference trajectory was not associated with clinical events (IRR: 0.94; 95% CI 0.83-1.07). Body mass index, mid-upper arm circumference, triceps skinfold, and mid-arm muscle circumference trajectories were independently associated with clinical events. Routinely assessing these simple measures in clinical practice may provide additional prognostic information for managing patients undergoing hemodialysis.

The Correlation between Nutritional Status and Clinical Outcome of Liver Sirosis Patients at RSUD Dr. Saiful Anwar Malang

Introduction: Nutritional status is often associated with mortality and disease morbidity, including liver cirrhosis. Assessment of Tricep Skin Fold (TSF) and mid-arm muscle circumference (MAMC) is an easy parameter of nutritional status.&#x0D; Objective: This study aims to determine the relationship between nutritional status and clinical outcomes in patients with liver cirrhosis.&#x0D; Methods: The study used a retrospective cohort observational design with a sample of 57 patients with liver cirrhosis with various etiologies. The data comes from the results of anthropometric measurements of patients in the poly or inpatient ward and interviews regarding the history of the disease and complications experienced during the last month. Data analysis used the Chi-square test with a 95% Confidence Interval (CI), p &lt; 0.05, to analyze the relationship between nutritional status (TSF and MAMC) with clinical outcomes of liver cirrhosis (hematemesis melena, degree of esophageal varices grade Hepatic encephalopathy (HE) and degree of ascites).&#x0D; Results: Based on the TSF and MAMC values, data on cirrhotic patients who experienced nutritional status with the “low” criteria were 33.3% and 57.89%, respectively. The 'low” TSF value significantly correlates with the HE incidence (p = 0.049) with the RR value of 0.461. The relationship between MAMC and the incidence of ascites was statistically significant (0.004), with an RR value of 0.462.&#x0D; Conclusion: Nutritional status affects the incidence of HE and ascites in liver cirrhosis patients