ROLE OF SARCOPENIA IN PAEDIATRIC METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE (MASLD).

Jayaprakash, K.; Wells, J.C.; Rajwal, S.; Stahlschmidt, J.; Humphrey, T.; Woodley, H.; Kyrana, E.

ROLE OF SARCOPENIA IN PAEDIATRIC METABOLIC DYSFUNCTION-ASSOCIATED STEATOTIC LIVER DISEASE (MASLD).

All Authors

Jayaprakash, K.

Wells, J.C.

Rajwal, S.

Stahlschmidt, J.

Humphrey, T.

Woodley, H.

Kyrana, E.

LTHT Author

Jayaprakash, Kavitha
Rajwal, Sanjay
Stahlschmidt, Jens
Humphrey, Terry
Woodley, Helen

LTHT Department

Leeds Children's Hospital
Children's Liver Unit
Pathology
Histopathology
Radiology
Paediatric Radiology
Ultrasound

Non Medic

Consultant Sonographer

Publication Date

2025

Item Type

Conference Abstract

Abstract

Studies in adults have demonstrated that the presence of sarcopenia in patients with MASLD is associated with a higher likelihood of steatohepatitis and advanced liver fibrosis independent of other confounding factors like age, sex, BMI and insulin resistance. Children diagnosed with MASLD undergoing liver biopsy were recruited to have body composition assessed by DXA scan and bioelectrical impedance (BIA). The participants also had HOMA-IR calculated as well as standard anthropometry and blood tests, ELF score, physical activity questionnaire score. Liver biopsies were assigned NAS score and fibrosis stage. Twenty children were recruited. Age 10-16 years (16M:4F). Median z-scores were for weight 2.69 (range 0.89 to 3.46), for height 0.86 (range - 0.17 to 2.87) and for BMI 2.31 (range 1.04 to 3.56). Eighteen children of these had whole body DXA scans, all had BIA. None of the children were sarcopenic as per definition of fat-free mass index (FFMI) z-score less than -2. All indices correlated with each other strongly (weight, BMI, total FMI, total FFMI, appendicular FMI and FFMI z-scores). Mean zscores for FFMI were significantly different to the corresponding FMI z-scores of the same child. NAS scores of liver biopsies: 2 scored 1, 4 scored 2, 6 scored 3, 7 scored 4 and 1 scored 5. Biopsies with a score equal or less than 3 were no MASH, over 3 with MASH. Fibrosis was staged as 0, 1a, 1b, 1c, 2, 3, and 4. No children had fibrosis stage 4, 5 had stage 3, 5 had stage 2, 5 were stage 1 and 3 were stage 0. Those with stage 0-1 we grouped as mild fibrosis, stage 2 and 3 were grouped as advanced fibrosis. The children classified as MASH had a higher cholesterol/ HDL ratio, but no significant anthropometric differences. The children with the more advanced fibrosis also had a higher cholesterol/HDL ratio but no anthropometric differences. In the advanced liver fibrosis group there was a tendency for more children to have a FFMI z-score in the lower quartile (75% vs 25%) on liver biopsy, but the numbers were small for more definite conclusions. %Lean mass (%LM) derived from the BIA correlated strongly with the FM indices from the DXA, implying that as fat mass increased the%LM was less, without necessarily an actual reduction in LM. HOMA-IR had a significant negative correlation with total body FFMI z-score -0.609 and other expressions of FFMI like (FFMI/FMI z-score or FFMI/BMI z-score). In our cohort of patients with biopsy proven MASLD, none of the patients were sarcopenic per se. HOMA-IR had a significant negative correlation with FFMI z-score. There was a tendency for the group with the more advanced liver fibrosis to have lean mass in the lower centiles.