Special Issue "Nutrition and Body Composition Assessment in Cirrhosis"

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (30 September 2020).

Special Issue Editors

Prof. Dr. Aldo J. Montano-Loza
E-Mail Website
Guest Editor
Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, AB T6G 2X8, Canada
Interests: sarcopenia; cirrhosis; nutrition; body composition; liver transplantation
Dr. Guido Stirnimann
E-Mail Website
Guest Editor
Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, 3010 Bern, Switzerland
Interests: sarcopenia; cirrhosis; nutrition; body composition
Dr. Maryam Ebadi
E-Mail Website
Guest Editor
Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB T6G 2X8, Canada
Interests: body composition; fat metabolism; adipose tissue; nutritional assessment
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

There is much interest currently around application of body composition for prognostication in cirrhosis. Quantification of body composition parameters provides objective estimation of patients’ nutritional and metabolic status, which is not considered in the current liver transplant allocation system. Presence of malnutrition and/or body composition abnormalities in patients with cirrhosis is associated with prolonged hospitalization, adverse outcomes, and incremental health care costs. Therefore, proper identification of these abnormalities is necessary to enable us to design interventions aiming at treating malnutrition and modifying body composition abnormalities and to preclude adverse outcomes in these patients.

Recently, a wealth of research on impaired nutritional status and abnormal body composition features in cirrhosis has emerged. This information has advanced our knowledge; however, the field is currently hampered by heterogeneous assessments and definitions of these abnormalities. This demonstrates the necessity to develop standardized assessment tools and definition that can be implemented in cirrhosis. The aim, then, of this Special Issue entitled “Nutrition and Body Composition Assessment in Cirrhosis” for the journal Nutrients is to invite contributions, either an original manuscript or review article, from researchers across multiple disciplines.

Submissions with a focus on nutrition screening, nutrition assessment, body composition assessment, abnormal body composition features, mechanisms of wasting in cirrhosis, and dietary interventions in cirrhosis are welcomed.

Prof. Aldo J. Montano-Loza
Dr. Guido Stirnimann
Dr. Maryam Ebadi
Guest Editors

Manuscript Submission Information

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Keywords

  • Body composition assessment in research and clinical practice in cirrhosis
  • Abnormal body composition features, in cirrhosis
  • Mechanisms of wasting in cirrhosis
  • Influences of body composition changes in cirrhosis
  • Nutritional assessment and status in cirrhosis
  • Dietary interventions in cirrhosis

Published Papers (4 papers)

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Research

Article
Sarcopenia Severity Based on Computed Tomography Image Analysis in Patients with Cirrhosis
Nutrients 2020, 12(11), 3463; https://doi.org/10.3390/nu12113463 - 11 Nov 2020
Cited by 4 | Viewed by 785
Abstract
Standardized sex-specific cut-offs for sarcopenia in cirrhosis are needed to identify the risk of clinical complications and to discriminate the severity of sarcopenia. We aimed to compare clinical characteristics between patients with cirrhosis categorized according to the severity of sarcopenia. Computed tomography images [...] Read more.
Standardized sex-specific cut-offs for sarcopenia in cirrhosis are needed to identify the risk of clinical complications and to discriminate the severity of sarcopenia. We aimed to compare clinical characteristics between patients with cirrhosis categorized according to the severity of sarcopenia. Computed tomography images were taken at the 3rd lumbar vertebra from 603 patients with cirrhosis and 129 adult donors for living liver transplantation. Patients with skeletal muscle index (SMI) two standard deviations (SD) below the sex-specific mean value of young donors (18–40 years old) were categorized as having severe sarcopenia whereas patients with SMI between −1 and −2 SD of the sex-specific young adult mean values were categorized as having sarcopenia. In the cirrhosis group, 408 patients (68%) were male with the mean age of 57 ± 0.4 years, and MELD score of 14 ± 0.4. Patients were divided into three groups: severe-sarcopenic (SMI < 30 cm2/m2 in females and <42 cm2/m2 in males), sarcopenic (30 ≤ SMI < 37 cm2/m2 in females and 42 ≤ SMI < 50 cm2/m2 in males) and non-sarcopenic (SMI ≥ 37 cm2/m2 in females and ≥50 cm2/m2 in males). Patients with cirrhosis and severe sarcopenia had lower muscle radiodensity and higher plasma neutrophil as well as neutrophil to lymphocyte ratio levels than both non- and sarcopenic groups. The frequency of alcohol-induced cirrhosis, refractory ascites, hepatic encephalopathy, CRP > 20 mg/mL, and severe malnutrition was also higher in severe-sarcopenic patients. The interval between sarcopenia and severe sarcopenia may reflect a window of opportunity in which to intervene and mitigate muscle wasting to improve patient outcomes. Full article
(This article belongs to the Special Issue Nutrition and Body Composition Assessment in Cirrhosis)
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Article
Supplemental Microalgal Iron Helps Replete Blood Hemoglobin in Moderately Anemic Mice Fed a Rice-Based Diet
Nutrients 2020, 12(8), 2239; https://doi.org/10.3390/nu12082239 - 27 Jul 2020
Cited by 1 | Viewed by 944
Abstract
Iron deficiency anemia affects 1.2 billion people globally. Our objectives were to determine if (1) supplemental iron extracted from defatted microalgae (Nannochloropsis oceanica, DGM) and (2) a combination of minute amount of plant phytase and inulin could help replete hemoglobin in anemic [...] Read more.
Iron deficiency anemia affects 1.2 billion people globally. Our objectives were to determine if (1) supplemental iron extracted from defatted microalgae (Nannochloropsis oceanica, DGM) and (2) a combination of minute amount of plant phytase and inulin could help replete hemoglobin in anemic mice. Mice (7 weeks old) were fed a control diet (6 mg Fe/kg). After 10 weeks, the mice were assigned to three treatments: control, control + DGM iron (Fe-DGM, 39 mg Fe/kg), or control + 1% inulin + 250 units of phytase/kg (INU−PHY, 6 mg Fe/kg). The mice had free access to diets and water for 6 weeks. The Fe-DGM group had elevated blood hemoglobin (p < 0.01) and a two-fold greater (p < 0.0001) liver non-heme iron over the control. Strikingly, the INU-PHY group had 34% greater non-heme iron than the control, despite the same concentrations of iron in their diets. Fe-DGM group had altered (p < 0.05) mRNA levels of hepcidin, divalent metal transporter 1, transferrin and transferrin receptor 1. Iron extracted from defatted microalgae seemed to be effective in alleviating moderate anemia, and INU-PHY enhanced utilization of intrinsic iron present in the rice diet. Our findings may lead to a novel formulation of these ingredients to develop safer and bioavailable iron supplements for iron-deficient populations. Full article
(This article belongs to the Special Issue Nutrition and Body Composition Assessment in Cirrhosis)
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Article
Effects of Branched-Chain Amino Acid (BCAA) Supplementation on the Progression of Advanced Liver Disease: A Korean Nationwide, Multicenter, Prospective, Observational, Cohort Study
Nutrients 2020, 12(5), 1429; https://doi.org/10.3390/nu12051429 - 15 May 2020
Cited by 9 | Viewed by 2121
Abstract
Background and Aims: Clinical evidence for the benefits of branched-chain amino acids (BCAAs) is lacking in advanced liver disease. We evaluated the potential benefits of long-term oral BCAA supplementation in patients with advanced liver disease. Methods: Liver cirrhosis patients with Child–Pugh (CP) scores [...] Read more.
Background and Aims: Clinical evidence for the benefits of branched-chain amino acids (BCAAs) is lacking in advanced liver disease. We evaluated the potential benefits of long-term oral BCAA supplementation in patients with advanced liver disease. Methods: Liver cirrhosis patients with Child–Pugh (CP) scores from 8 to 10 were prospectively recruited from 13 medical centers. Patients supplemented with 12.45 g of daily BCAA granules over 6 months, and patients consuming a regular diet were assigned to the BCAA and control groups, respectively. The effects of BCAA supplementation were evaluated using the model for end-stage liver disease (MELD) score, CP score, serum albumin, serum bilirubin, incidence of cirrhosis-related events, and event-free survival for 24 months. Results: A total of 124 patients was analyzed: 63 in the BCAA group and 61 in the control group. The MELD score (p = 0.009) and CP score (p = 0.011) significantly improved in the BCAA group compared to the control group over time. However, the levels of serum albumin and bilirubin in the BCAA group did not improve during the study period. The cumulative event-free survival was significantly improved in the BCAA group compared to the control group (HR = 0.389, 95% CI = 0.221–0.684, p < 0.001). Conclusion: Long-term supplementation with oral BCAAs can potentially improve liver function and reduce major complications of cirrhosis in patients with advanced liver disease. Full article
(This article belongs to the Special Issue Nutrition and Body Composition Assessment in Cirrhosis)
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Communication
Validation of Malnutrition Screening Tools in Liver Cirrhosis
Nutrients 2020, 12(5), 1306; https://doi.org/10.3390/nu12051306 - 03 May 2020
Cited by 5 | Viewed by 1275
Abstract
Malnutrition in liver cirrhosis is frequently underestimated. To determine if a patient is at risk of malnutrition, several screening tools have been established. However, most of them are not validated for patients with liver cirrhosis. Therefore, we compared the RFH-NPT (Royal Free Hospital [...] Read more.
Malnutrition in liver cirrhosis is frequently underestimated. To determine if a patient is at risk of malnutrition, several screening tools have been established. However, most of them are not validated for patients with liver cirrhosis. Therefore, we compared the RFH-NPT (Royal Free Hospital Nutritional Prioritizing Tool) as the validated gold standard for malnutrition screening in cirrhosis patients with GMS (Graz Malnutrition Screening), NRS-2002 (Nutritional Risk Screening) and MNA-SF (Mini Nutritional Assessment-Short Form). Based on common validity criteria for screening tools, only the MNA-SF showed fair correlation (12/15 points) with the RFH-NPT, whereas NRS-2002 and GMS performed worse (6/15 points). Taken together, our results suggest that NRS-2002 and GMS are not suitable for screening of malnutrition in cirrhosis patients. A cirrhosis-specific screening tool like RFH-NPT should be used to assess malnutrition and to identify those at risk of malnutrition. Full article
(This article belongs to the Special Issue Nutrition and Body Composition Assessment in Cirrhosis)
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