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

BACKGROUND
Sarcopenia is defined as reduced skeletal muscle mass (SMM) or myopenia and altered muscle function and physical performance. It is currently unknown whether myopenia in children with end-stage liver disease (ESLD) adversely impacts clinical outcomes. We hypothesized that myopenia would be prevalent in children with ESLD and related to suboptimal nutritional intake contributing to gross motor and growth delay, increased hospitalization and medical complications.


METHODS
This retrospective study involved evaluation of abdominal imaging (CT/MRI) for skeletal muscle mass (SMM) (total, psoas, paraspinal, abdominal wall muscle; cm2 /height2 ) and adipose tissue (total, visceral, subcutaneous (SAT), intermuscular fat) determinations at L3/L4 vertebrates at LTx assessment. ESLD children (n = 30) were age and gender matched to healthy controls (HC; n = 24). Myopenia was defined as SMM-index z-score ←2 and low SAT was defined as SAT index z-score ←1.5. Anthropometrics, biochemical and clinical data (hospitalization, complications, growth, neurodevelopment, energy/protein intake) were collected at LTx assessment, LTx, post-LTx (first hospitalization, 6 & 12 months).


RESULTS
Four distinct body composition phenotypes in infants and children with ESLD awaiting LTx were found, a) myopenia with low SAT (17%), b) myopenia (3%), c) low SAT (20%), d) normal muscle mass and SAT (60%). Myopenia in the presence of low SAT was prevalent in older (>2 years), male children and was associated with gross motor delay, reduced energy intake, 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 is important. This article is protected by copyright. All rights reserved.