Journal of Cachexia, Sarcopenia and Muscle最新文献

We read with great interest the recent article by Welsh et al. titled ‘Change in physical activity and its association with decline in kidney function: A UK Biobank-based cohort study’ in Journal of Cachexia, Sarcopenia and Muscle [1]. The study finds that increased physical activity may protect kidney function, as suggested by the modest yet significant associations observed in large-scale analyses using eGFRCysC measurements. However, we note several biases in the use of the Cox proportional hazards (CoxPH) model that the authors did not address.

The established criteria may result in mixed censoring outcomes, that is, right-censoring and interval-censoring events [2, 3]. Events of kidney function diagnosed through medical records could result in interval-censoring if they occurred between follow-up visits, and right-censoring for diagnosed between the end of follow-up and the time of data analysis. The CoxPH model primarily handles right-censored data. In contrast, the accelerated failure time (AFT) model is often preferred for scenarios involving various types of censored data [4]. The AFT model can effectively handle left-censored, right-censored and interval-censored data by appropriately adjusting the likelihood function [5]. By using the ‘survival’ and ‘icenReg’ packages, mixed censored data can be fitted and analysed, and event times can be estimated [6].

Moreover, the CoxPH model requires the proportional hazards assumption, meaning that covariate effects are constant over time [7]. If this assumption is violated, the model may not provide unbiased estimates of the coefficients, and the predictions may not be reliable. The authors should utilize Schoenfeld residuals or alternative methods to evaluate the proportional hazards assumption for the association between covariates and the risk of kidney function. Schoenfeld residuals are calculated as the differences between the observed and expected values of covariates at each failure time [8]. If the residuals exhibit a systematic change over time, it suggests that the effect of the covariate may be time-dependent. When the proportional hazards assumption does not hold, authors should use a stratified Cox model, a Cox model with time-varying effects, or an AFT model instead of the standard CoxPH model [4, 9].

In conclusion, we believe that a re-evaluation considering the potential impact of censoring events and the proportional hazards assumption is necessary. Further research is anticipated to provide more empirical data and clearer insights into this field.

We read with great interest the article by Lu et al. [1] regarding the impact of myosteatosis on post–liver transplantation (LT) outcome in males transplanted for hepatocellular carcinoma (HCC). The authors reported a relatively low prevalence of myosteatosis (27.8% in males) using a gender-based definition (i.e., muscle attenuation less than 37.5 HU at the third lumbar vertebra of cross-sectional CT image for men). However, in our recently published meta-analysis [2] including 10 studies with 3316 HCC patients, the overall pooled prevalence of myosteatosis was estimated as high as 50% (95% confidence interval [CI] 35%–65%) [2]. This discrepancy could be attributed to the fact that Lu et al. [1] included mainly chronic hepatitis B–associated HCC patients, although all patients were Asians. Indeed, our meta-analysis showed that the prevalence of myosteatosis is significantly lower in Asian HCC patients, compared to the non-Asian HCC patients (pooled prevalence 45% vs. 69%, respectively, p = 0.02), whereas viral-associated HCC patients have significantly less frequently myosteatosis, compared to those with fatty or alcoholic liver disease–associated HCC (pooled prevalence 49% vs. 65% vs. 86%, respectively, p < 0.001). Interestingly, the authors [1] concluded that myosteatosis was not associated with post-LT outcome in females, although they did not provide which cutoff was used for definition of myosteatosis in this subgroup, although no clear explanation was given for this finding. In addition, they found no association between myosteatosis and hepatic encephalopathy although our meta-analysis [3] showed that cirrhotic patients with myosteatosis, compared to those without myosteatosis, have more frequently a previous history of hepatic encephalopathy (32% vs. 15%, p = 0.04) possibly related with the reduction of skeletal muscle capacity to remove ammonia. Finally, it would be interesting if the authors evaluated the impact of diabetes mellitus, which is an known factor associated with myosteatosis and poor prognosis after LT [3, 4], as well as if they compared the post-LT outcome of HCC patients with sarcopenia and myosteatosis/isolated myosteatosis versus those with isolated sarcopenia, as recent studies have shown that myosteatosis may be a more important factor, compared to sarcopenia, in the pre-LT setting of patients without HCC [5].

Nevertheless, Lu et al. [1] confirmed the predictive role of myosteatosis in HCC patients not only in the pre-LT setting [2] but also in the post-LT outcome [1], indicating the importance of including assessment of myosteatosis in the process for LT evaluation. However, their results [1] need validation in non-Asian populations, in which the aetiology of liver disease is more frequently metabolic and alcohol-related HCC.

I have read with great interest the article published in the Journal of Cachexia, Sarcopenia and Muscle on the knowledge and practices in anorexia of ageing (AA) diagnosis and management in Japan [1]. The study provides valuable insights into the current state of AA management among healthcare professionals in Japan, emphasizing the critical role of continuing education. While the article is well written and contributes meaningfully to the field, I believe there are several areas where constructive suggestions could further enhance the interpretation and application of the results.

From a statistical perspective, the study has some limitations that merit consideration. The use of descriptive statistics and chi-square tests to compare differences between the education and non-education groups is commendable. However, incorporating multivariable regression models could make the analysis even more insightful, as these models would effectively control for potential confounding factors such as participants' work experience, institutional resources and overall attitudes towards elderly care. Additionally, examining interaction effects could significantly enhance the persuasiveness of the study's findings. Education may impact the management of AA differently across various professions, regions or institutions. Considering these interaction effects within the statistical models would provide a deeper understanding of how these factors collectively influence the results [2].

To address the challenges highlighted by this study, I propose a multidisciplinary approach involving community health initiatives. A coordinated effort that includes healthcare providers, community health workers, social workers and government officials could create a more supportive environment for managing AA. For example, community-based nutrition education programmes could be developed to reach a broader audience, including those outside academic settings. Additionally, leveraging the role of community health workers to monitor and manage AA in older adults could enhance early detection and intervention [3], particularly in underserved areas.

In conclusion, while the article offers valuable contributions to understanding AA management in Japan, our suggestions aim to make an already excellent article even better. I look forward to seeing continued efforts from healthcare professionals, volunteers, government officials and social workers to create a healthier and more supportive environment for older adults.

Background: Obesity is a significant risk factor for the progression of non-alcoholic fatty liver disease (NAFLD). However, a convenient and efficacious non-invasive test for monitoring NAFLD progression in patients with obesity is currently lacking. This study aims to investigate the associations between CT-based body composition and the progression of biopsy-proven NAFLD in patients with obesity.

Methods: Liver biopsy was conducted in patients with obesity, and the progression of NAFLD was evaluated by the NAFLD activity score (NAS). Body composition was assessed through abdominal computed tomography (CT) scans.

Results: A total of 602 patients with an average age of 31.65 (±9.33) years old were included, comprising 217 male patients and 385 female patients. The wall skeletal muscle index (SMI), total SMI, and visceral fat index (VFI) were positively correlated with NAS in both male and female patients. Multivariate regression analysis demonstrated significant associations between high liver steatosis and wall SMI (HR: 1.60, 95% CI: 1.12 to 2.30), total SMI (HR: 1.50, 95% CI: 1.02 to 2.08), VSI (HR: 2.16, 95% CI: 1.48 to 3.14), visceral fat to muscle ratio (HR: 1.51, 95% CI: 1.05 to 2.18), and visceral to subcutaneous fat ratio (HR: 1.51, 95% CI: 1.07 to 2.12). Non-alcoholic steatohepatitis (NASH) was significantly associated with wall SMI (HR: 1.52, 95% CI: 1.06 to 2.19) and VSI (HR: 1.50, 95% CI: 1.03 to 2.17). Liver fibrosis ≥ F2 was significantly associated with psoas muscle index (HR: 0.64, 95% CI: 0.44 to 0.93) and psoas skeletal muscle density (HR: 0.61, 95% CI: 0.41 to 0.89).

Conclusions: Our study suggested that certain CT-based body composition indicators, notably high VFI, were significantly associated with the progression of NAFLD in patients with obesity. Great attentions and timely managements should be given to these patients with body composition characteristics associated with the risk of NAFLD progression.