Associação entre sarcopenia e massa óssea com variavéis clínicas, nutricionais, virológicas e estilo de vida em pacientes com hepatite C crônica

Abstract

Introduction: Chronic hepatitis C (HCC) is one of the most serious public health problems in the world, being considered a relevant cause of chronic liver disease. HCV has been associated with extrahepatic disorders like the changes in bone kinetics characterized by a decreased bone formation and increased bone reabsorption. Moreover, patients with liver diseases are at high risk for the development of malnutrition and sarcopenia. Objective: To evaluate the association between low phase angle, low fat free mass, sarcopenia and low bone mass with clinical, nutritional, biochemical, hematological, and lifestyle variables in patients with chronic hepatitis C (HCC). Methods: A total of 135 subjects [mean age, 52.4 ± 11.8 yrs.; 50.4% males; 65.9% non-cirrhotic and 34.1% compensated cirrhotic patients] were prospectively enrolled. Fat free mass, phase angle and reactance/height were measured by Bioimpedance (BIA). Subjective global assessment (SGA) and CONtrolling NUTritional status (CONUT) were used to assess malnutrition. Body mass index (BMI) and mid-arm muscle circumference were measured. Bone mineral density (BMD), bone mineral content (BMC) and appendicular skeletal muscle mass index (ASMI) were obtained by DXA. Muscle strength was assessed by dynamometry. Presarcopenia and sarcopenia were diagnosed according to the European Working Group on Sarcopenia in Older People recommendation. Demographic, lifestyle, laboratory and clinical variables were also evaluated. Results: Low fat free mass and low PhA were identified in 21.5% and 23.7% of patients, respectively. Compensated cirrhotic patients had lower PhA values than those without cirrhosis. Low fat free mass was associated with male sex and malnutrition. Low PhA was associated with cirrhosis, malnutrition and current alcohol use. Reactance (Xc) normalized for height (H), an indicator of muscle strength, was independently associated with male sex, age, hypertension and albumin. Low BMD was found in 34.6% of subjects with HCC. In the multivariate analysis appendicular skeletal muscle mass index was an independent predictor of BMD. Neither fat mass nor body mass index (BMI) was associated with BMD. Low muscle strength, presarcopenia and sarcopenia were found in 27.9%, 14.4% and 8.7% patients, respectively. In multivariate analysis, malnutrition and BMC were positively and negatively associated with sarcopenia, respectively. A positive correlation was found between MAMC (mid-arm muscle circumference) and appendicular skeletal muscle mass index (ASMI). When MAMC instead of ASMI was used to assess muscle mass, moderate and substantial agreement was found between MAMC and ASMI in the evaluation of presarcopenia and sarcopenia, respectively. Conclusion: In patients chronically infected with HCV, without cirrhosis and with compensated cirrhosis, two relevant parameters of BIA, reduced fat free mass and low phase angle, were associated with clinical comorbidities, nutritional status and lifestyle. On the other hand, when the evaluation of the body composition and the bone mass was made by using of DEXA, an inverse association was found between sarcopenia and bone mass. This is the first study that demonstrated a positive association between muscle mass, muscle strength and bone mass in non-cirrhotic and compensated cirrhotic patients with CHC. Further studies are needed to understand the interaction between skeletal muscle, bone and liver in order to enable an expanded clinical care of this population.