Sarcopenia in children and adolescents with chronic liver disease

Rezende, Ionar Figueredo Bonfim; Conceição-Machado, Maria Ester P.; Souza, Viviane Sahade; Santos, Elisana M. dos; Silva, Luciana R.

doi:10.1016/j.jped.2019.02.005

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Original articles • J. Pediatr. (Rio J.) 96 (4) • Jul-Aug 2020 • https://doi.org/10.1016/j.jped.2019.02.005 copy

Sarcopenia in children and adolescents with chronic liver disease^☆ ☆ Please cite this article as: Rezende IF, Conceição-Machado ME, Souza VS, Santos EM, Silva LR. Sarcopenia in children and adolescents with chronic liver disease. J Pediatr (Rio J). 2020;96:439-46. , ^☆☆ ☆☆ Study conducted at Complexo Hospitalar Professor Edgar Santos (C-HUPES), Serviço de Gastroenterologia e Hepatologia Pediátricas; and Universidade Federal da Bahia (UFBA), Instituto de Ciências da Saúde, Programa de Pós-graduação em Processos Interativos dos Órgãos e Sistemas, Salvador, BA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate the occurrence of sarcopenia in children and adolescents with chronic liver disease.

Methods:

A series of cases, with patients aged 6-19 years of both genders, who were treated in Liver Outpatient Clinics. Weight, height, muscle strength (assessed by manual grip strength), and muscle mass (estimated through dual-energy X-ray absorptiometry) were measured. Sarcopenia was diagnosed based on the simultaneous presence of muscle mass and muscle strength déficits, defined as the values below the mean for muscle mass and strength of the studied population, according to gender. A descriptive analysis (mean and standard deviation) was performed, and the difference of means was calculated by Student's t-test.

Results:

A total of 85 patients were studied, mostly females (64.7%), with a mean age of 11.7 (SD = 3.4) years. Sarcopenia was identified in 40% of the patients. Muscle strength déficit was found in 54.1% of the subjects, and 50.6% showed muscle mass déficit. The mean muscle mass for males was higher than that for females (6.07; SD = 1.22 kg/m² vs. 5.42; SD = 1.10 kg/m²; p = 0.016). However, there was no significant difference in sex-related muscle strength (male = 0.85; SD = 0.52 kgf/kgm² and female = 0.68; SD = 0.30 kgf/kgm²; p = 0.113).

Conclusion:

The research findings identified that sarcopenia is a condition found in pediatric patients treated at a public referral institution for chronic liver disease.

KEYWORDS
Sarcopenia; Muscle mass; Muscle strength; Liver diseases; Children; Adolescents

Age range (years)	n	BMI (kg/m²)		ASM (kg)		SMI (kg/m²)		FMGS (kgf)		rMGS (kgf/kgm²)
Age range (years)	n	Mean (SD)	p ^a a Student's t-test.	Mean (SD)	p ^a a Student's t-test.	Mean (SD)	p ^a a Student's t-test.	Mean (SD)	p ^a a Student's t-test.	Mean (SD)	p ^a a Student's t-test.
<10			0.995		0.015		0.069		0.617		0.795
Male	6	16.5 (1.02)		8.7 (1.23)		5.5 (0.95)		6.8 (3.20)		0.4 (0.18)
Female	19	16.5 (3.09)		6.9 (1.52)		4.6 (1.04)		6.3 (2.13)		0.4 (0.15)
≥10 and ≤14			0.574		0.636		0.564		0.749		0.803
Male	15	20.0 (3.62)		12.7 (3.47)		5.9 (1.11)		15.5 (7.79)		0.81 (0.45)
Female	29	20.7 (3.62)		13.1 (2.69)		5.8 (0.96)		16.2 (5.60)		0.78 (0.24)
>14			0.899		0.22		0.302		0.311		0.27
Male	8	21.7 (4.92)		17.6 (4.55)		6.7 (1.45)		27.7 (13.27)		1.3 (0.57)
Female	8	22.0 (3.81)		15.0 (3.39)		6.1 (0.64)		22.2 (6.56)		1.0 (0.24)

Variables	Sarcopenic		Non-sarcopenic		p-Value^c c Pearson's chi-squared test.
Variables	n	%	n	%	p-Value^c c Pearson's chi-squared test.
Gender					0.262
Male	14	41.2	15	29.4
Female	20	58.8	36	70.6
Age range (years)					0.000
<10 years	19	55.9	6	11.8
≥10 years	15	44.1	45	88.2
Pubertal development					0.019^d d Fisher's exact test.
Prepubertal	5	33.3	3	6.7
Pubertal + post-pubertal	10	66.7	42	93.7
Corticoid use					1.0
Yes	6	17.6	9	17.6
No	28	82.4	42	82.4
Cirrhosis					0.572
Yes	10	29.4	18	35.3
No	24	70.6	33	64.7
Anthropometric status (BMI/A)					0.472
Underweight + normal weight^a a Patients classified according to BMI/A as underweight and normal weight, respectively (8.8%, n = 3, 70.6%, n = 24).	27	79.4	37	72.5
Overweight + obesity^b b Patients classified according to BMI/A as overweight and obese, respectively (11.8%, n = 4, 8.8%, n = 3).	7	20.6	14	27.5
Muscle strength (rMGS)					0.000
Low	34	100	12	23.5
Adequate	0	0	39	76.5
Muscle mass (SMI)					0.000
Low	34	100	9	17.6
Adequate	0	0	42	82.4

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[1] * Corresponding author. E-mail: ionar.nutricionista@yahoo.com.br (I.F. Rezende).