Muscle atrophy as pre-sarcopenia in Japanese patients with chronic liver disease: computed tomography is useful for evaluation

The definition of muscle atrophy (pre-sarcopenia) and its diagnostic criteria have not been well reported. To elucidate the frequency of pre-sarcopenia in chronic liver disease (CLD), we examined clinical features of Japanese CLD patients using abdominal computed tomography (CT) findings. We enrolled 988 CLD (736 with na < ve hepatocellular carcinoma) and 372 normal control subjects (NCs). The psoas muscle area index [PI, psoas muscle area at the mid-L3 level in CT (cm(2))/height (m)(2)] was calculated using personal computer software. The cut-off level for pre-sarcopenia was defined as less than two standard deviations (SDs) below the mean PI value in the NCs under 55 years old [males, 45.6 +/- A 5.7 years (n = 61), 4.24 cm(2)/m(2); females, 47.0 +/- A 6.1 years (n = 49), 2.50 cm(2)/m(2)]. Elderly was defined as 65 years or older. Clinical features were retrospectively evaluated. In the CLD group (HCV:HBV:HBV and HCV:alcohol:non-HBV and HCV = 652:88:7:82:159), pre-sarcopenia was observed in 15.3 % of patients with chronic hepatitis (CH), 24.4 % of those with liver cirrhosis (LC) Child-Pugh A, 37.7 % of those with LC Child-Pugh B, and 37.1 % of those with LC Child-Pugh C. A comparison between NC and CH by age (< 55, 55-64, 65-74, a parts per thousand yen75 years) showed that the frequency of pre-sarcopenia was higher in CH regardless of age (1.8 vs. 3.6 %, 3.2 vs. 15.9 %, 4.9 vs. 13.4 %, 14.3 vs. 20.2 %, respectively). PI values showed correlations with BMI (r = 0.361), age (r = -0.167), albumin (r = 0.115), and branched-chain amino acids (r = 0.199) (P < 0.01). Retrospective evaluate for pre-sarcopenia was easy to perform with CT findings. Nutrition and exercise instruction should be considered for early stage and even non-elderly CLD as well as LC.