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( Kazuko Iwata ),( Nagisa Hara ),( Masumi Ishidome ),( Hirohide Miyachi ),( Motoh Iwasa ),( Yoshiyuki Takei ) 한국정맥경장영양학회 2014 한국정맥경장영양학회 학술대회집 Vol.2014 No.-
Objective: Liver cirrhosis (LC) is frequently complicated by protein-energy malnutrition (PEM) and the prognosis in such patients is poor. The body composition of patients with PEM comprises increased total body water and decreased fat and muscle mass. Body composition analyzers based on multi-frequency bioelectrical impedance (MF-BIA) are becoming increasingly available in clinical settings. Functional hepatic reserve as represented by the Child-Pugh score is often used to determine survival prognosis in LC patients; however, the relationship between body composition and prognosis has not been adequately investigated. Furthermore, while differences in body composition between men and women are known to exist in healthy populations, the details of sex differences in body composition in LC patients are unclear. The present study measured body composition in LC patients using BIA, analyzed the relationship between body composition and survival prognosis, and investigated sex differences. Methods: Adult patients with LC who underwent nutritional assessment at our hospital were eligible. In addition to blood screening and evaluation of clinical characteristics, body mass index (BMI; kg/m2), visceral fat area (VFA; cm2), edema rate (extracellular water/total body water); and regional skeletal muscle mass (kg) were measured using an InBody720® (Biospace) body composition analyzer. Patient survival rates were investigated and Kaplan-Meier survival analysis was performed using each parameter: sex, age (cutoff: 65 years), presence or absence of secondary hepatocellular carcinoma (HCC), serum albumin (cutoff: 3.5 g/dl), Child-Pugh classification (A vs. B+C), use or non-use of branched chain amino acids (BCAAs), BMI (cutoff: 22 kg/m2), VFA (cutoff: 70 cm2), arm index (arm skeletal muscle mass/height; cutoff: men, 1.7 kg/m2; women, 1.2 kg/m2) and edema rate (cutoff: 0.398). Results: Subjects comprised 161 LC patients (94 men, 67 women; mean age, 67.9 years). The causative factors of LC comprised hepatitis B virus (n=9), hepatitis C virus (n=101), alcoholism (n=26) and other causes (n=25). The mean Child-Pugh score was 6.8±1.7 and 81 subjects had HCC (50%). No sex differences were observed for serum albumin levels, LC severity, or HCC rates. Survival analysis by sex revealed that survival prognosis was worse among elderly women but was unaffected by the presence or absence of HCC in either sex. In both men and women, serum albumin <3.5 g/dl, a Child-Pugh classification of B or C, and use of BCAAs were all associated with poorer prognosis. With regard to body composition parameters, survival prognosis was worse for men with a decreased VFA and arm index and women with a high edema rate. Conclusion: Because BIA is based on measurements of total body water, its accuracy is affected by edemaand ascites. In the present study, arm measurements were used to evaluate skeletal muscle in order to minimize these effects. The present findings revealed that survival prognosis in LC is related to body composition parameters such as decreased VFA, arm index and high edema rate, in addition to known factors such as low serum albumin and a high Child-Pugh score. BIA is a useful method of assessing body composition; however, the sex differences in body composition mean that care is required when estimating survival prognosis based on body composition measurements in women.
Mei Uemura,Yutaka Yano,Toshinari Suzuki,Taro Yasuma,Toshiyuki Sato,Aya Morimoto,Samiko Hosoya,Chihiro Suminaka,Hiromu Nakajima,Esteban C. Gabazza,Yoshiyuki Takei 대한당뇨병학회 2017 Diabetes and Metabolism Journal Vol.41 No.4
patients and institutions. We are developing a glucose area under the curve (AUC) monitoring system without blood sampling using a minimally invasive interstitial fluid extraction technology (MIET). Here we evaluated the accuracy of interstitial fluid glucose (IG) AUC measured by MIET in patients with diabetes for an extended time interval and the potency of detecting hyperglycemia using CGM data as a reference. Methods: Thirty-eight inpatients with diabetes undergoing CGM were enrolled. MIET comprised a pretreatment step using a plastic microneedle array and glucose accumulation step with a hydrogel patch, which was placed on two sites from 9:00 AM to 5:00 PM or from 10:00 PM to 6:00 AM. IG AUC was calculated by accumulated glucose extracted by hydrogel patches using sodium ion as standard. Results: A significant correlation was observed between the predicted AUC by MIET and CGM in daytime (r=0.76) and nighttime (r=0.82). The optimal cutoff for the IG AUC value of MIET to predict hyperglycemia over 200 mg/dL measured by CGM for 8 hours was 1,067.3 mg·hr/dL with 88.2% sensitivity and 81.5% specificity. Conclusion: We showed that 8-hour IG AUC levels using MIET were valuable in estimating the blood glucose AUC without blood sampling. The results also supported the concept of using this technique for evaluating glucose excursion and for screening hyperglycemia during 8 hours in patients with diabetes at any time of day.