Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2023

Open Access 01-12-2023 | Malnutrition | Research article

Fat mass: a novel digital biomarker for remote monitoring that may indicate risk for malnutrition and new complications in decompensated cirrhosis

Authors: K. Gananandan, V. Thomas, W. L. Woo, R. Boddu, R. Kumar, M. Raja, A. Balaji, K. Kazankov, R. P. Mookerjee

Published in: BMC Medical Informatics and Decision Making | Issue 1/2023

Login to get access

Abstract

Background

Cirrhosis is associated with sarcopaenia and fat wasting, which drive decompensation and mortality. Currently, nutritional status, through body composition assessment, is not routinely monitored in outpatients. Given the deleterious outcomes associated with poor nutrition in decompensated cirrhosis, there is a need for remotely monitoring this to optimise community care.

Methods

A retrospective analysis was conducted on patients monitored remotely with digital sensors post hospital discharge, to assess outcomes and indicators of new cirrhosis complications. 15 patients had daily fat mass measurements as part of monitoring over a median 10 weeks, using a Withing’s bioimpedance scale. The Clinical Frailty Score (CFS) was used to assess frailty and several liver disease severity scores were assessed.

Results

73.3% (11/15) patients were male with a median age of 63 (52–68). There was a trend towards more severe liver disease based on CLIF-Consortium Acute Decompensation (CLIF-C AD) scores in frail patients vs. those not frail (53 vs 46, p = 0.072). When the cohort was split into patients who gained fat mass over 8 weeks vs. those that lost fat mass, the baseline CLIF-C AD scores and WBC were significantly higher in those that lost fat (58 vs 48, p = 0.048 and 11.2 × 109 vs 4.7 × 109, p = 0.031).

Conclusions

This proof-of-principle study shows feasibility for remote monitoring of fat mass and nutritional reserve in decompensated cirrhosis. Our results suggest fat mass is associated with greater severity of acute decompensation and may serve as an indicator of systemic inflammatory response. Further prospective studies are required to validate this digital biomarker.
Literature
1.
2.
Jalan R, Pavesi M, Saliba F, Amorós A, Fernandez J, Holland-Fischer P, et al. The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J Hepatol. 2015;62(4):831–40.CrossRefPubMed
3.
Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426-1437.e9.CrossRefPubMed
4.
Meyer F, Bannert K, Wiese M, Esau S, Sautter LF, Ehlers L, et al. Molecular mechanism contributing to malnutrition and sarcopenia in patients with liver cirrhosis. Int J Mol Sci. 2020;21(15):5357.CrossRefPubMedPubMedCentral
5.
Lautz HU, Selberg O, Körber J, Bürger M, Müller MJ. Protein-calorie malnutrition in liver cirrhosis. Clin Investig. 1992;70(6):478.CrossRefPubMed
6.
D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44(1):217–31.CrossRefPubMed
7.
Okafor PN, Nnadi AK, Okoli O, Huang AE, Nwaiwu O. Same- vs different-hospital readmissions in patients with cirrhosis after hospital discharge. Am J Gastroenterol. 2019;114(3):464–71.CrossRefPubMed
8.
Bajaj JS, Reddy KR, Tandon P, Wong F, Kamath PS, Garcia-Tsao G, et al. The 3-month readmission rate remains unacceptably high in a large North American cohort of patients with cirrhosis. Hepatology. 2016;64(1):200–8.CrossRefPubMed
9.
Merli M, Lucidi C, Giannelli V, Giusto M, Riggio O, Falcone M, et al. Cirrhotic patients are at risk for health care-associated bacterial infections. Clin Gastroenterol Hepatol. 2010;8(11):979-985.e1.CrossRefPubMed
10.
da SilvaAlvares Mário R, da SilveiraReverbel T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition. 2005;21(2):113–7.CrossRef
11.
Mendenhall C, Roselle GA, Gartside P, Moritz T. Relationship of protein calorie malnutrition to alcoholic liver disease: a reexamination of data from two veterans administration cooperative studies. Alcohol Clin Exp Res. 1995;19(3):635–41.CrossRefPubMed
12.
Lai JC, Tandon P, Bernal W, Tapper EB, Ekong U, Dasarathy S, et al. Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American association for the study of liver diseases. Hepatology. 2021;74(3):1611–44.CrossRefPubMed
13.
14.
Xiao HJ, Ye Q, Zhang M, Qi YM, Han T, Wang X. Risk factors of cirrhosis combined with sarcopenia and their impact on clinical outcomes. Zhonghua Gan Zang Bing Za Zhi. 2020;28(1):53–7.PubMed
15.
Figueiredo FAF, de Mello Perez R, Kondo M. Effect of liver cirrhosis on body composition: evidence of significant depletion even in mild disease. J Gastroenterol Hepatol. 2005;20(2):209–16.CrossRefPubMed
16.
Grover I, Singh N, Gunjan D, Pandey RM, Chandra Sati H, Saraya A. Comparison of anthropometry, bioelectrical impedance, and dual-energy X-ray absorptiometry for body composition in cirrhosis. J Clin Exp Hepatol. 2022;12(2):467–74.CrossRef
17.
18.
Kyle UG, Bosaeus I, de Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, et al. Bioelectrical impedance analysis—part II: utilization in clinical practice. Clin Nutr. 2004;23(6):1430–53.CrossRef
19.
Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr. 1985;41(4):810–7.CrossRefPubMed
20.
21.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.CrossRefPubMedPubMedCentral
22.
23.
Carey EJ, Lai JC, Wang CW, Dasarathy S, Lobach I, Montano-Loza AJ, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl. 2017;23(5):625–33.CrossRefPubMedPubMedCentral
24.
Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1–85.PubMed
25.
Kamath P. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–70.CrossRefPubMed
26.
Pirlich M, Schutz T, Spachos T, Ertl S, Weis M, Lochs H, et al. Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites. Hepatology. 2000;32(6):1208–15.CrossRefPubMed
27.
Ruiz-Margáin A, Xie JJ, Román-Calleja BM, Pauly M, White MG, Chapa-Ibargüengoitia M, et al. Phase angle from bioelectrical impedance for the assessment of sarcopenia in cirrhosis with or without ascites. Clin Gastroenterol Hepatol. 2021;19(9):1941-1949.e2.CrossRefPubMed
28.
Viertel M, Bock C, Reich M, Löser S, Plauth M. Performance of CT-based low skeletal muscle index, low mean muscle attenuation, and bioelectric impedance derived low phase angle in the detection of an increased risk of nutrition related mortality. Clin Nutr. 2019;38(5):2375–80.CrossRefPubMed
29.
Bellafronte NT, Diani LM, Vega-Piris L, Cuadrado GB, Chiarello PG. Comparison between dual-energy x-ray absorptiometry and bioelectrical impedance for body composition measurements in adults with chronic kidney disease: A cross-sectional, longitudinal, multi-treatment analysis. Nutrition. 2021;82: 111059.CrossRefPubMed
30.
Morley JE, Vellas B, van KanAbella G, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7.CrossRefPubMedPubMedCentral
31.
Wang S, Whitlock R, Xu C, Taneja S, Singh S, Abraldes JG, et al. Frailty is associated with increased risk of cirrhosis disease progression and death. Hepatology. 2022;75(3):600–9.CrossRefPubMed
32.
Laube R, Wang H, Park L, Heyman JK, Vidot H, Majumdar A, et al. Frailty in advanced liver disease. Liver Int. 2018;38(12):2117–28.CrossRefPubMed
33.
Tandon P, Tangri N, Thomas L, Zenith L, Shaikh T, Carbonneau M, et al. A rapid bedside screen to predict unplanned hospitalization and death in outpatients with cirrhosis: a prospective evaluation of the clinical frailty scale. Am J Gastroenterol. 2016;111(12):1759–67.CrossRefPubMed
34.
Dunn MA, Josbeno DA, Tevar AD, Rachakonda V, Ganesh SR, Schmotzer AR, et al. Frailty as tested by gait speed is an independent risk factor for cirrhosis complications that require hospitalization. Am J Gastroenterol. 2016;111(12):1768–75.CrossRefPubMed
35.
Mazurak VC, Tandon P, Montano-Loza AJ. Nutrition and the transplant candidate. Liver Transpl. 2017;23(11):1451–64.CrossRefPubMed
36.
Thongprayoon C, Cheungpasitporn W, Kashani K. Serum creatinine level, a surrogate of muscle mass, predicts mortality in critically ill patients. J Thorac Dis. 2016;8(5):E305–11.CrossRefPubMedPubMedCentral
37.
38.
Trebicka J, Fernandez J, Papp M, Caraceni P, Laleman W, Gambino C, et al. The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology. J Hepatol. 2020;73(4):842–54.CrossRefPubMed
39.
40.
Dolz C, Raurich JM, Ibanez J, Obrador A, Marse P, Gaya J. Ascites increases the resting energy expenditure in liver cirrhosis. Gastroenterology. 1991;100(3):738–44.CrossRefPubMed
41.
Campillo B, Phuong NB, Pornin B, Devanlay M. Influence of liver failure, ascites, and energy expenditure on the response to oral nutrition in alcoholic liver cirrhosis. Nutrition. 1997;13(7):613–21.CrossRefPubMed
Metadata
Title
Fat mass: a novel digital biomarker for remote monitoring that may indicate risk for malnutrition and new complications in decompensated cirrhosis
Authors
K. Gananandan
V. Thomas
W. L. Woo
R. Boddu
R. Kumar
M. Raja
A. Balaji
K. Kazankov
R. P. Mookerjee
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Malnutrition
Published in
BMC Medical Informatics and Decision Making / Issue 1/2023
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-023-02288-z

Other articles of this Issue 1/2023

BMC Medical Informatics and Decision Making 1/2023 Go to the issue

Research

The willingness to continue using wearable devices among the elderly: SEM and FsQCA analysis

Correction

Correction: The impact of data from remote measurement technology on the clinical practice of healthcare professionals in depression, epilepsy and multiple sclerosis: survey

Research Article

Development of a real-world database for asthma and COPD: The SingHealth-Duke-NUS-GSK COPD and Asthma Real-World Evidence (SDG-CARE) collaboration

Research

An automated detection of epileptic seizures EEG using CNN classifier based on feature fusion with high accuracy

Research

Extracting the latent needs of dementia patients and caregivers from transcribed interviews in japanese: an initial assessment of the availability of morpheme selection as input data with Z-scores in machine learning

Research

Effects of a shared decision making intervention for older adults with multiple chronic conditions: the DICO study