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Perspectives on Sarcopenia as a Predictor for Outcomes in Pediatric Patients with Chronic Liver Disease
Connie Chen1, Mary Ayers1, Judy H Squires2
1Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
Insights
Sarcopenia, a loss of muscle mass and function, affects 24-70% of children with liver disease. It indicates more severe illness but isn't linked to standard growth metrics or the PELD score.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Muscle Physiology
- Clinical Nutrition
Background:
- Sarcopenia, characterized by muscle mass and function decline, is a significant factor in chronic diseases, particularly end-stage liver disease (ESLD) in adults.
- While extensively studied in adults with ESLD, the role and prevalence of sarcopenia in pediatric liver disease remain underexplored.
- Existing pediatric studies are limited, small-scale, and use varied definitions, necessitating further investigation.
Purpose of the Study:
- To review and summarize current literature on sarcopenia in children with liver disease.
- To assess the prevalence, clinical associations, and impact of sarcopenia on pediatric liver disease outcomes.
- To identify standardized methods for sarcopenia assessment in this population.
Main Methods:
- Systematic review and synthesis of published studies on sarcopenia in pediatric liver disease.
- Analysis of reported prevalence rates, clinical correlations (e.g., disease severity, PELD score, anthropometrics), and post-transplant outcomes.
- Evaluation of different muscle mass quantification techniques, including total psoas muscle surface area (tPMSA).
Main Results:
- Sarcopenia prevalence in pediatric liver disease ranges from 24% to 70% across reviewed studies.
- Sarcopenia is associated with more severe liver disease but is independent of the Pediatric End-Stage Liver Disease (PELD) score, age, gender, and standard anthropometric measures (BMI, weight-for-height).
- While some studies suggest sarcopenia is a risk factor for adverse post-transplant outcomes, these findings lack consistent replication across cohorts.
Conclusions:
- Sarcopenia is a prevalent condition in children with liver disease, often indicating greater disease severity.
- Standardized anthropometric measures and the PELD score do not effectively identify sarcopenia in these children.
- Recent definition of normative values for muscle quantification methods like tPMSA offers a basis for future standardized research on sarcopenia's impact in pediatric liver disease.
Abstract:
Sarcopenia, a pathologic deficiency of muscle mass and function, has emerged as an important secondary feature of many chronic disease states. For adults with end stage liver disease, there are multiple mechanisms which contribute to sarcopenia and its presence has proven to be an important predictor of morbidity and mortality. In children, there are only a limited number of reports which investigate the role of sarcopenia in liver disease. These studies, which are discussed and summarized in this review, report small, single-center analyses with dissimilar study cohorts and varying clinical definitions. Still, children meeting the study entry criteria have sarcopenia with a reported prevalence of 24-70%. When assessed, sarcopenia appears to be associated with more severe disease but is independent of the Pediatric End-Stage Liver Disease (PELD) score and does not correlate with age, gender, or traditional anthropometric measures such as weight, height, weight-for-height, or body mass index (BMI). While individual studies may identify sarcopenia as a statistically significant risk factor for certain post-transplant outcomes such as longer ICU stay, longer duration of intubation, repeat operation, development of serious infection, longer hospital stay, death, or long-term growth failure, such associations are not consistently replicated across studies. Finally, although various methods of muscle mass quantification are utilized, the most reported is the total psoas muscle surface area (tPMSA) on computed tomography. This method, along with others such as skeletal muscle area and skeletal muscle index, have had normative values recently defined and these collective efforts should enable researchers a common basis of comparison when delineating sarcopenia, and its impact, across various study populations in future investigations - including in children with liver disease.
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