Sarcopenia is associated with clinical outcomes and physical function in children with end-stage liver disease pre-and-post liver transplantation

• Author / Creator

  Poh Hwa Ooi

• Background & Aims: Sarcopenia is defined as reduced skeletal muscle mass (myopenia), muscle strength and physical performance. In adults with end stage liver disease (ESLD), sarcopenia is highly prevalent and associated with adverse outcomes. Emerging data have shown that sarcopenia is prevalent in children before and after liver transplantation (LTx). Little information is available regarding the associations of sarcopenia with clinical outcomes and the risk factors influencing the expression of sarcopenia. The study aims were to determine the prevalence of sarcopenia in children with ESLD before and after LTx and to study associations of sarcopenia with clinical outcomes. In study 1, we described myopenia in ESLD children awaiting LTx and associations with adverse clinical outcomes up to 1 year post-LTx. In study 2, we determined sarcopenia using adult consensus definitions which included skeletal muscle mass (SMM), muscle strength and physical performance measures and explored lifestyle factors (dietary quality and physical activity) that may influence sarcopenia risk/expression.
  Methods: Study 1 was a retrospective review study involving SMM and adipose tissues measurements in ESLD children (n=30) with MRI/CT images performed during LTx assessment. Age and gender matched healthy control (HC; n=24) with MRI/CT was included. Clinical outcomes studied include growth, neuro-development, medical complications (e.g. infection, hospitalization). In study 2, body composition was measured using Dual Energy X-ray absorptiometry and multiple skinfolds. Muscle strength/function was assessed using handgrip, sit-to-stand, push-up, stair climb tests, 6 minute walk tests in post-LTx children (n=22) and age matched HC (n=47). Habitual physical activity and dietary intake were assessed using accelerometer (2 weeks) and 3-day food records, respectively.
  Results: In study 1, myopenia and low subcutaneous adipose tissues were highly prevalent in ESLD children affecting up to 37% of children prior to LTx. Males and older age (>2 years) were the major risk factors. These conditions were associated with gross motor delay, longer hospitalization and increased risk for infection. In Study 2, sarcopenia was prevalent in up to 36% of children post-LTx and was associated with deficits in lower limb muscle strength/function (sit to stand, push-ups, and stair climb tests) and lower level of vigorous physical activity. Diet quality was poor but unrelated to sarcopenia expression.
  
  Conclusions: Myopenia associated with low subcutaneous fat deposition and reduced peripheral limb strength/function was highly prevalent in children pre-and-post-LTx and associated with adverse clinical outcomes. Development of rehabilitation strategies to identify and treat sarcopenia is important to optimize clinical outcomes in children with ESLD pre-and-post LTx.

• Subjects / Keywords

  • Liver transplantation
  • Sarcopenia
  • Children

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-ws2v-1r38

• License

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