Patients with autoimmune hepatitis (AIH) and primary or autoimmune sclerosing cholangitis are at nutritional risk; their body composition and has not been extensively studied. We aimed to describe their body composition and identify clinical links.
Using MRI, two reviewers segmented total psoas muscle area (tPMSA), visceral fat area (VFA) and subcutaneous fat area (mm2 ) and measured visceral and subcutaneous thickness (mm). Clinical, laboratory, and quality of life (QoL; using PedsQL) data were collected. Sarcopenia was defined as tPMSA ≤5th percentile. ANOVA, wilcoxon rank test, and multivariable modeling were performed. A pediatric cohort with NAFLD was used as a comparator following propensity score matching.
58 patients with AILD (33 [57%] with AIH) were included: median age 16 years (IQR: 13-18), 33 (57%) male. Median time from diagnosis to MRI was 15 months (IQR: 2-39 months). Two patients (3%) had a BMIz indicative of mild malnutrition. tPMSA was measurable in 52 subjects (90%). Of those, 25 (48%) had sarcopenia. Sarcopenic patients had a lower BUN compared to non-sarcopenic (median [IQR]: 9.5 [8.0, 12.0] vs. 11 [10, 14] mg/dL; p=0.023). There was no difference in corticosteroid use between groups. The VFA of sarcopenic patients was higher (3156 [2064, 7492]) vs. 2084 [688, 3092]) mm2 ; p=0.005). Patient-reported QoL negatively associated with VFA and general health negatively associated with VFA. Compared with NAFLD, the odds ratio for sarcopenia with AILD was 14.5 (95%CI: 2.3- 90.7).
In autoimmune liver diseases, sarcopenia is highly prevalent, associated with increased visceral fat and QoL.
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