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May Skeletal Muscle Index Predicts Mortality in Individuals with Cirrhosis?

  • André Pontes-Silva
    Correspondence
    Address for correspondence: Universidade Federal de São Carlos, Departamento de Fisioterapia, Programa de Pós-Graduação em Fisioterapia, Rod. Washington Luis, Km 235, CEP 13565-905, São Carlos, SP, Brazil.
    Affiliations
    Postgraduate Program in Physical Therapy (PPGFT), Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil

    Postgraduate Program in Adult Health (PPGSAD), Biological and Health Sciences Center (CCBS), Universidade Federal Do Maranhão (UFMA), São Luís, MA, Brazil

    Technician Full Profile Anthropometrist (Level 2), International Society for the Advancement of Kinanthropometry (ISAK), Buriticupu, Maranhão, Brazil
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Published:August 05, 2022DOI:https://doi.org/10.1016/j.jceh.2022.07.250
      I read with great appreciation the study “European working group on sarcopenia in older people (EWGSOP2) criteria with population-based skeletal muscle index best predicts mortality in Asians with cirrhosis”.
      • Anand A.
      • Mohta S.
      • Agarwal S.
      • et al.
      European working group on sarcopenia in older people (EWGSOP2) criteria with population-based skeletal muscle index best predicts mortality in Asians with cirrhosis.
      The authors estimated the prevalence of sarcopenia based on four criteria and assessed their utility in predicting mortality in cirrhotics. The paper has an elegant rationale, and I am sure that will generate new research; however, some points of the paper reduce the clinical applicability of these results.
      The authors describe that the handgrip strength was measured using a digital hand dynamometer according to standard protocols (p. 53); however, these “standard protocols” comes from a systematic review,
      • Sousa-Santos A.R.
      • Amaral T.F.
      Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review.
      whose conclusion states that the majority of the studies included did not describe a complete procedure of handgrip strength measurement; the high heterogeneity between the protocols used, in the sarcopenia and frailty studies, create an enormous difficulty in drawing comparative conclusions among them.
      • Sousa-Santos A.R.
      • Amaral T.F.
      Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review.
      In addition, the body mass index (BMI) must be (always!) evaluated with additional measures capable of representing body proportionality, e.g., waist perimeter divided by the stature in centimeters (waist-to-stature ratio),
      • Xiangfeng C.
      • Shaobo L.
      • Tingling X.
      • Wenjuan W.
      • Jixiang M.
      • Jianhong L.
      Relationship between waist-to-height ratio and overall and type specific incidence of stroke in adults in China: a prospective study.
      ,
      • Lo K.
      • Wong M.
      • Khalechelvam P.
      • Tam W.
      Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis.
      sagittal abdominal diameter,
      • Møller G.
      • Ritz C.
      • Kjølbæk L.
      • et al.
      Sagittal abdominal diameter and waist circumference appear to be equally good as identifiers of cardiometabolic risk.
      • Saad M.A.N.
      • Jorge A.J.L.
      • de Ávila D.X.
      • et al.
      Sagittal abdominal diameter as a marker of visceral obesity in older primary care patients.
      • Li C.
      • Harris M.
      • Tsilimingras D.
      • Liu S.Z.
      • Sheng Y.
      • Liu X.
      Sagittal abdominal diameter and its socioeconomic correlates: perspective of sex differences.
      or both indices (as they are easy, noninvasive, and clinicians/scientists take <2 min to do this). I think that before reaching the conclusion of the best predictor (highlighted on the title), for any health condition, it is important to check the patients’ abdominal obesity.
      • Silveira E.A.
      • Kliemann N.
      • Noll M.
      • Sarrafzadegan N.
      • de Oliveira C.
      Visceral obesity and incident cancer and cardiovascular disease: an integrative review of the epidemiological evidence.
      To contribute to the authors, I present a mathematical model that has scientific support for clinical applicability, whose body proportionality (as well as patients’ abdominal obesity) can be obtained through the waist-to-stature ratio: waist perimeter (cm)/stature (cm). The cut-off point is < 0.50 (i.e., the central perimeter must be less than 50% of human stature).
      • Rodrigues A.L.M.
      • Gotardelo M.P.S.
      • Pontes-Silva A.
      • Quaresma F.R.P.
      • Maciel E. da S.
      Clinical variables considered risk factors for the metabolic syndrome: a cross-sectional study.
      ,
      • Maciel E. da S.
      • Silva B.K.R.
      • Figueiredo F.W.
      • et al.
      Physical inactivity level and lipid profile in traditional communities in the Legal Amazon: a cross-sectional study.
      Finally, in the scientific context, we need to use the technical terms, e.g., “circumference” is wrong—measurements of body surfaces are called “perimeters”, “height” must be “stature”, and “weight” should be “body mass” (note that the concept of BMI is body [mass] index, not body [weight] index).

      References

        • Anand A.
        • Mohta S.
        • Agarwal S.
        • et al.
        European working group on sarcopenia in older people (EWGSOP2) criteria with population-based skeletal muscle index best predicts mortality in Asians with cirrhosis.
        J Clin Exp Hepatol. 2022; 12: 52-60https://doi.org/10.1016/j.jceh.2021.03.015
        • Sousa-Santos A.R.
        • Amaral T.F.
        Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review.
        BMC Geriatr. 2017; 17https://doi.org/10.1186/s12877-017-0625-y
        • Xiangfeng C.
        • Shaobo L.
        • Tingling X.
        • Wenjuan W.
        • Jixiang M.
        • Jianhong L.
        Relationship between waist-to-height ratio and overall and type specific incidence of stroke in adults in China: a prospective study.
        Chin J Endemiol. 2021; 42: 2010-2017https://doi.org/10.3760/cma.j.cn112338-20200812-01064
        • Lo K.
        • Wong M.
        • Khalechelvam P.
        • Tam W.
        Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis.
        Obes Rev. 2016; 17: 1258-1275https://doi.org/10.1111/obr.12456
        • Møller G.
        • Ritz C.
        • Kjølbæk L.
        • et al.
        Sagittal abdominal diameter and waist circumference appear to be equally good as identifiers of cardiometabolic risk.
        Nutr Metab Cardiovasc Dis. 2021; 31: 518-527https://doi.org/10.1016/j.numecd.2020.09.032
        • Saad M.A.N.
        • Jorge A.J.L.
        • de Ávila D.X.
        • et al.
        Sagittal abdominal diameter as a marker of visceral obesity in older primary care patients.
        J Geriatr Cardiol. 2020; 17: 279-283https://doi.org/10.11909/j.issn.1671-5411.2020.05.007
        • Li C.
        • Harris M.
        • Tsilimingras D.
        • Liu S.Z.
        • Sheng Y.
        • Liu X.
        Sagittal abdominal diameter and its socioeconomic correlates: perspective of sex differences.
        BMC Publ Health. 2021; 21: 1-10https://doi.org/10.1186/s12889-020-09805-z
        • Silveira E.A.
        • Kliemann N.
        • Noll M.
        • Sarrafzadegan N.
        • de Oliveira C.
        Visceral obesity and incident cancer and cardiovascular disease: an integrative review of the epidemiological evidence.
        Obes Rev. 2021; 22: 1-17https://doi.org/10.1111/obr.13088
        • Rodrigues A.L.M.
        • Gotardelo M.P.S.
        • Pontes-Silva A.
        • Quaresma F.R.P.
        • Maciel E. da S.
        Clinical variables considered risk factors for the metabolic syndrome: a cross-sectional study.
        Esc Anna Nery. 2022; 26: 1-8https://doi.org/10.1590/2177-9465-ean-2021-0321en
        • Maciel E. da S.
        • Silva B.K.R.
        • Figueiredo F.W.
        • et al.
        Physical inactivity level and lipid profile in traditional communities in the Legal Amazon: a cross-sectional study.
        BMC Publ Health. 2022; 22: 1-9https://doi.org/10.1186/s12889-022-12973-9