Loss of skeletal muscle mass affects the incidence of minimal hepatic encephalopathy: a case control study
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RESEARCH ARTICLE
Loss of skeletal muscle mass affects the incidence of minimal hepatic encephalopathy: a case control study Masakuni Tateyama1, Hideaki Naoe1, Motohiko Tanaka1*, Kentaro Tanaka1, Satoshi Narahara1, Takayuki Tokunaga1, Takeshi Kawasaki1, Yoko Yoshimaru1, Katsuya Nagaoka1, Takehisa Watanabe1, Hiroko Setoyama1,2, Yutaka Sasaki1,3 and Yasuhito Tanaka1
Abstract Background: Sarcopenia is a syndrome characterized by progressive and systemic decreases in skeletal muscle mass and muscle strength. The influence or prognosis of various liver diseases in this condition have been widely investigated, but little is known about whether sarcopenia and/or muscle mass loss are related to minimal hepatic encephalopathy (MHE). Methods: To clarify the relationship between MHE and sarcopenia and/or muscle mass loss in patients with liver cirrhosis. Methods: Ninety-nine patients with liver cirrhosis were enrolled. MHE was diagnosed by a neuropsychiatric test. Skeletal mass index (SMI) and Psoas muscle index (PMI) were calculated by dividing skeletal muscle area and psoas muscle area at the third lumbar vertebra by the square of height in meters, respectively, to evaluate muscle volume. Results: This study enrolled 99 patients (61 males, 38 females). MHE was detected in 48 cases (48.5%) and sarcopenia in 6 cases (6.1%). Patients were divided into two groups, with or without MHE. Comparing groups, no significant differences were seen in serum ammonia concentration or rate of sarcopenia. SMI was smaller in patients with MHE (46.4 cm2/m2) than in those without (51.2 c m2/m2, P = 0.027). Similarly, PMI was smaller in patients with MHE (4.24 cm2/ m2) than in those without (5.53 c m2/m2, P = 0.003). Skeletal muscle volume, which is represented by SMI or PMI was a predictive factor related to MHE (SMI ≥ 50 cm2/m2; odds ratio 0.300, P = 0.002, PMI ≥ 4.3 cm2/m2; odds ratio 0.192, P = 0.001). Conclusions: Muscle mass loss was related to minimal hepatic encephalopathy, although sarcopenia was not. Measurement of muscle mass loss might be useful to predict MHE. Keywords: Minimal hepatic encephalopathy, Skeletal muscle index, Liver cirrhosis, Sarcopenia
*Correspondence: mtanaka03@kumamoto‑u.ac.jp 1 Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1‑1‑1, Chuo‑ku, Kumamoto 860‑8556, Japan Full list of author information is available at the end of the article
Background Hepatic encephalopathy (HE) is a complication of liver cirrhosis, and reduces quality of life (QOL) for the patient. Minimal HE (MHE) is a neuropsychiatric abnormality without clinical overt symptoms of HE [1–3], and is diagnosed using sensitive neuropsychological and neurophysiological examinations. Difficulty in diagnosing MHE aggravates not only QOL, but also
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