Top

Published in:

01-08-2016 | Original Article

Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients

Authors: L. Augusti, L. C. Franzoni, L. A. A. Santos, T. B. Lima, M. V. Ietsugu, K. H. Koga, S. M. Moriguchi, L. E. Betting, C. A. Caramori, G. F. Silva, F. G. Romeiro

Published in: Metabolic Brain Disease | Issue 4/2016

Abstract

Hepatic encephalopathy (HE) is a late complication of liver cirrhosis and is clearly associated with poor outcomes. Chronic liver insufficiency leads to progressive muscle wasting, impairing ammonia metabolism and thus increasing the risk for HE. Given the association between lean mass and adductor pollicis muscle thickness (APMT), it has been used to predict outcome and complications in many conditions, but not yet in cirrhotic patients. Therefore, this article aimed to study the association between HE manifestations and measures related to muscle mass and strength. This cross-sectional study included 54 cirrhotic outpatients with HE varying from subclinical to grade II according to the West-Haven criteria, who were submitted to neuropsychometric tests, electroencephalogram, brain Single Photon Emission Computed Tomography (SPECT), anthropometric measurements, handgrip strength (HGS) and dual energy X-ray absorptiometry exam (DXA). Multiple logistic regression analysis was performed to investigate the association between body composition measures and HE grade. Analysis of the area under the receiver operator characteristic (AUROC) curve revealed the values related to neurological manifestations (HE grades I and II). Reductions in APMT and HGS were associated with higher HE grades, suggesting a big impact caused by the loss of muscle mass and function on HE severity. The link between HE manifestations and anthropometric measures, namely APMT and HGS, point to a significant relation concerning skeletal muscles and the neurological impairment in this population.

Álvares-da-Silva MR (2005) Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 21(2):113–117CrossRefPubMed

Amodio P, Marchetti P, Del Piccolo F, de Tourtchaninoff M, Varghese P, Zuliani C, Campo G, Gatta A, Guérit JM (1999) Spectral versus visual EEG analysis in mild hepatic encephalopathy. Clin Neurophysiol 110(8):1334–1344CrossRefPubMed

Amodio P, Montagnese S, Gatta A, Morgan MY (2004) Characteristics of minimal hepatic encephalopathy. Metab Brain Dis 19(3–4):253–267CrossRefPubMed

Bajaj JS, Wade JB, Gibson DP, Heuman DM, Thacker LR, Sterling RK, Stravitz RT, Luketic V, FucHGS M, White MB, Bell DE, Gilles H, Morton K, Noble N, Puri P, Sanyal AJ (2011) The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 106(9):1646–1653. doi:10.1038/ajg.2011.157 CrossRefPubMedPubMedCentral

Baumgartner RN (2000) Body composition in healthy aging. Ann N Y Acad Sci 904:437–448CrossRefPubMed

Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763. doi:10.1093/oxfordjournals.aje.a009520 CrossRefPubMed

Bémeur C, Desjardins P, Butterworth RF (2010) Role of nutrition in the management of hepatic encephalopathy in end-stage liver failure. J Nutr Metab 2010:489823. doi:10.1155/2010/489823 CrossRefPubMedPubMedCentral

Berzigotti A, Garcia-Tsao G, Bosch J, Grace ND, BurrougHGS AK, Morillas R, Escorsell A, Garcia-Pagan JC, Patch D, Matloff DS, Groszmann RJ, Portal Hypertension Collaborative Group (2011) Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology 54:555–561. doi:10.1002/hep.24418 CrossRefPubMedPubMedCentral

Bianchi G, Giovagnoli M, Sasdelli AS, Marchesini G (2012) Hepatic encephalopathy and health-related quality of life. Clin Liver Dis 16(1):159–170. doi:10.1016/j.cld.2011.12.003 CrossRefPubMed

Bielemann RM, Horta BL, Orlandi SP, Barbosa-Silva TG, Gonzalez MC, Assunção MC, Gigante DP (2015) Is adductor pollicis muscle thickness a good predictor of lean mass in adults? Clin Nutr. doi:10.1016/j.clnu.2015.07.022

Blackburn GL, Harvey KB (1982) Nutritional assessment as a routine in clinical medicine. Postgrad Med 71:46–63PubMed

Blei AT (2000) Diagnosis and treatment of hepatic encephalopathy. Baillieres Best Pract Res Clin Gastroenterol 14(6):959–974CrossRefPubMed

Blei AT, Córdoba J (2001) Hepatic encephalopathy. Practice parameters Committee of the American College of gastroenterology. Am J Gastroenterol 96(7):1968–1976CrossRefPubMed

Butterworth RF (2002) Pathophysiology of hepatic encephalopathy: a new look at ammonia. Metab Brain Dis 17(4):221–227CrossRefPubMed

Callaway CW, Chumlea WC, Bouchard C, Himes JH, Lohman TG, Martin AD, et al. (1988) Circumferences. In: Lohman TG, Roche AF, Martorell R (eds) Anthropometric standardizing reference manual. Human Kinetics, Champaign, pp. 39–54

Caporossi FS, Caporossi C, Borges Dock-Nascimento D, de Aguilar-Nascimento JE (2012) Measurement of the thickness of the adductor pollicis muscle as a predictor of outcome in critically ill patients. Nutr Hosp 27(2):490–495. doi:10.1590/S0212-16112012000200021 PubMed

Carvalho L, Parise ER (2006) Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis. Arq Gastroenterol 43(4):269–274CrossRefPubMed

Chadalavada R, Biyyani RSS, Maxwell J, Muleen K (2010) Nutrition in hepatic encephalopathy. Nutr Clin Pract 5:257–264. doi:10.1177/0884533610368712 CrossRef

Cheung K, Lee S, Raman M (2012) Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol 10:117–125. doi:10.1016/j.cgh.2011.08.016 CrossRefPubMed

de Oliveira CM, Kubrusly M, Mota RS, Choukroun G, Neto JB, da Silva CA (2012) Adductor pollicis muscle thickness: a promising anthropometric parameter for patients with chronic renal failure. J Ren Nutr 22(3):307–316. doi:10.1053/j.jrn.2011.07.006 CrossRefPubMed

Figueiredo FA, Dickson ER, Pasha TM, Porayko MK, Therneau TM, Malinchoc M, et al. (2000) Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease. Liver Transpl 6:575–581CrossRefPubMed

Harrison GG, Buskirk EK, Carter JEL, Ohmston JFE, Lohman TG, Pollock ML, et al. (1988) Skinfold thicknesses and measurements technique. In: Lohman TG, Roche AF, Martorell R (eds) Anthropometric standardizing reference manual. Human Kinetics, Champaign, pp. 55–80

Hayashi F, Matsumoto Y, Momoki C, Yuikawa M, Okada G, Hamakawa E, et al. (2013) Physical inactivity and insufficient dietary intake are associated with the frequency of sarcopenia in patients with compensated viral liver cirrhosis. Hepatol Res 43(12):1264–1275CrossRefPubMed

Huisman EJ, Trip EJ, Siersema PD, van Hoek B, van Erpecum KJ (2011) Protein energy malnutrition predicts complications in liver cirrhosis. Eur J Gastroenterol Hepatol 23:982–989. doi:10.1097/MEG.0b013e32834aa4bb CrossRefPubMed

Iwasa M, Hara N, Terasaka E, Hattori A, Ishidome M, Mifuji-Moroka R, Miyachi H, Sugimoto R, Tanaka H, Fujita N, Kobayashi Y, Iwata K, Takei Y (2014) Evaluation and prognosis of sarcopenia using impedance analysis in patients with liver cirrhosis. Hepatol Res 44(10):E316–E317. doi:10.1111/hepr.12217 CrossRefPubMed

James R (1989) Nutritional support in alcoholic liver disease: a review. J Hum Nutr 2315-23

Jeejeebhoy KN (2012) Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia: overlap of clinical features. Curr Opin Clin Nutr Metab Care 15:213–219. doi:10.1097/MCO.0b013e328352694f CrossRefPubMed

Kalaitzakis E, Olsson R, Henfridsson P, Hugosson I, Bengtsson M, Jalan R, Björnsson E (2007) Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis. Liver Int 27:1194–1201. doi:10.1111/j.1478-3231.2007.01562.x PubMed

Lameu EB, Gerude MF, Campos AC, Luiz RR (2004) The thickness of the adductor pollicis muscle reflects the muscle compartment and may be used as a new anthropometric parameter for nutritional assessment. Curr Opin Clin Nutr Metab Care 7(3):293–301CrossRefPubMed

Leong Shu-Fen C, Ong V, Kowitlawakul Y, Ling TA, Mukhopadhyay A, Henry J (2015) The adductor pollicis muscle: a poor predictor of clinical outcome in ICU patients. Asia Pac J Clin Nutr 24(4):605–609. doi:10.6133/apjcn.2015.24.4.22 PubMed

McCullough AJ, Mullen KD, Kalhan SC (1991) Measurements of total body and extracellular water in cirrhotic patients with and without ascites. Hepatology 14:1102–1111. doi:10.1002/hep.1840140626 CrossRefPubMed

Merli M, Giusto M, Lucidi C, Giannelli V, Pentassuglio I, Di Gregorio V, Lattanzi B, Riggio O (2013) Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study. Metab Brain Dis 28(2):281–284. doi:10.1007/s11011-012-9365-z

Montano-Loza AJ, Meza-Junco J, Prado CM, Lieffers JR, Baracos VE, Bain VG, Sawyer MB (2012) Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol 10:166–173. doi:10.1016/j.cgh.2011.08.028 CrossRefPubMed

Morano GN, Seibyl JP (2003) Technical overview of brain SPECT imaging: improving acquisition and processing of data. J Nucl Med Technol 31:191–195PubMed

Peng S, Plank LD, McCall JL, Gillanders LK, McIlroy K, Gane EJ (2007) Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr 85:1257–1266PubMed

Periyalwar P, Dasarathy S (2012) Malnutrition in cirrhosis: contribution and consequences of sarcopenia on metabolic and clinical responses. Clin Liver Dis 16:95–131. doi:10.1016/j.cld.2011.12.009 CrossRefPubMedPubMedCentral

Plauth M, Cabré E, Riggio O, Assis-Camilo M, Pirlich M, Kondrup J (2006) ESPEN guidelines on enteral nutrition: liver disease. Clin Nutr 25:285–294. doi:10.1016/j.clnu.2006.01.018 CrossRefPubMed

Poziomyck AK, Weston AC, Lameu EB, Cassol OS, Coelho LJ, Moreira LF (2012) Preoperative nutritional assessment and prognosis in patients with foregut tumors. Nutr Cancer 64(8):1174–1181. doi:10.1080/01635581.2012.721157 CrossRefPubMed

Prado CMM, Wells JCK, Smith SR, Stephan BCM, Siervo M (2012) Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr 31:583–601CrossRefPubMed

Riggio O, Andreoli A, Diana F, Fiore P, Meddi P, Lionetti R, Montagnese F, Merli M, Capocaccia L, De Lorenzo A (1997) Whole body and regional body composition analysis by dual-energy X-ray absorptiometry in cirrhotic patients. Eur J Clin Nutr 51:810–814CrossRefPubMed

Romeiro FG, Augusti L (2015) Nutritional assessment in cirrhotic patients with hepatic encephalopathy. World J Hepatol 7(30):2940–2954. doi:10.4254/wjh.v7.i30.2940 CrossRefPubMedPubMedCentral

Romero-Gómez M, Montagnese S, Jalan R (2015) Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure. J Hepatol 62:437–447. doi:10.1016/j.jhep.2014.09.005 CrossRefPubMed

Stewart CA, Malinchoc M, Kim WR, Kamath PS (2007) Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. Liver Transpl 13:1366–1371. doi:10.1002/lt.21129 CrossRefPubMed

Sunil HV, Mittal BR, Kurmi R, Chawla YK, Dhiman RK (2012) Brain perfusion single photon emission computed tomography abnormalities in patients with minimal hepatic encephalopathy. J Clin Exp Hepatol 2(2):116–121CrossRefPubMedPubMedCentral

Tapper EB, Jiang ZG, Patwardhan VR (2015) Refining the Ammonia Hypothesis: A Physiology-Driven Approach to the Treatment of Hepatic Encephalopathy. Mayo Clin Proc 90(5):646–658. doi:10.1016/j.mayocp.2015.03.003 CrossRefPubMed

Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P (2014a) Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 60:715–735. doi:10.1002/hep.27210 CrossRefPubMed

Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P (2014b) Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the liver and the American Association for the Study of Liver Diseases. American Association for the Study of Liver Diseases; European Association for the Study of the liver. J Hepatol 61(3):642–659. doi:10.1016/j.jhep.2014.05.042 CrossRef

Waters DL, Qualls CR, Dorin RI, Veldhuis JD, Baumgartner RN (2008) Altered growth hormone, cortisol, and leptin secretion in healthy elderly persons with sarcopenia and mixed body composition phenotypes. J Gerontol A Biol Sci Med Sci 63(5):536e41CrossRef

Title: Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients
Authors: L. Augusti
L. C. Franzoni
L. A. A. Santos
T. B. Lima
M. V. Ietsugu
K. H. Koga
S. M. Moriguchi
L. E. Betting
C. A. Caramori
G. F. Silva
F. G. Romeiro
Publication date: 01-08-2016
Publisher: Springer US
Published in: Metabolic Brain Disease / Issue 4/2016
Print ISSN: 0885-7490
Electronic ISSN: 1573-7365
DOI: https://doi.org/10.1007/s11011-016-9828-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2016

Piperine potentiates the effects of trans-resveratrol on stress-induced depressive-like behavior: involvement of monoaminergic system and cAMP-dependent pathway

Behavioural effects of basal ganglia rho-kinase inhibition in the unilateral 6-hydroxydopamine rat model of Parkinson’s disease

Rhizophora mucronata attenuates beta-amyloid induced cognitive dysfunction, oxidative stress and cholinergic deficit in Alzheimer’s disease animal model

Evaluation of whole blood zinc and copper levels in children with autism spectrum disorder

TDO as a therapeutic target in brain diseases

Identifying minimal hepatic encephalopathy in cirrhotic patients by measuring spontaneous brain activity