Impaired lower limb muscle mass, quality and function in end stage liver disease: a cross‐sectional study

Quinlan, JI, Dhaliwal, A, Williams, FR, Allen, SL, Choudhary, S, Rowlands, A, Breen, L, Lavery, GG ORCID: https://orcid.org/0000-0001-5794-748X, Lord, JM, Elsharkawy, AM, Armstrong, MJ and Greig, CA, 2023. Impaired lower limb muscle mass, quality and function in end stage liver disease: a cross‐sectional study. Experimental Physiology, 108 (8), pp. 1066-1079. ISSN 0958-0670

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Abstract

Sarcopenia is associated with reduced quality of life and increased mortality in patients with end stage liver disease (ESLD). Historically, sarcopenia identification in ESLD utilised L3 skeletal muscle index (SMI). There are few data on muscle quality and function within lower limb muscle groups with high functional relevance. The aim of this prospective case-control study was to evaluate the quadriceps muscle in patients with ESLD. Muscle mass and quality were evaluated using MRI (quadriceps anatomical cross sectional area (ACSA), quadriceps volume index, L3 SMI, quadriceps intermuscular adipose tissue (IMAT)), mid-arm muscle circumference (MAMC) and ultrasonography (vastus lateralis (VL) thickness and quadriceps ACSA). Muscle strength/function was assessed by handgrip strength, peak quadriceps isokinetic torque and chair rise time. Thirty-nine patients with ESLD (55 years, 61% male, 48% alcoholic related liver disease (ArLD), 71% Child-Pugh B/C) and 18 age/sex-matched healthy control participants (HC) were studied. Quadriceps mass was significantly reduced in ESLD versus HC (-17%), but L3 SMI and MAMC were unchanged. Quadriceps IMAT percentage was increased in ESLD (+103%). Handgrip strength (-15%), peak isokinetic torque (-29%), and chair rise time (+56%) were impaired in ESLD. Ultrasound measures of VL thickness (r = 0.56, r = 0.57, r = 0.42) and quadriceps ACSA (r = 0.98, r = 0.86, r = 0.67) correlated to MRI quadriceps ACSA, quadriceps volume and L3 SMI, respectively. Quadriceps muscle mass, quality, and function were impaired in patients with ESLD, whereas conventional assessments of muscle (L3 SMI and MAMC) highlighted no differences between ESLD and HC. Full evaluation of lower limb muscle health is essential in ESLD in order to accurately assess sarcopenia and target future interventions.

Highlights:
What is the central question of this study? To what extent does musculoskeletal impairment occur (i.e., muscle mass, quality and function) in patients with end stage liver disease (ESLD) by comparison to a healthy age/sex-matched control group?
What is the main finding and its importance? Muscle mass, quality and function are impaired in patients with ESLD (compared to age/sex matched controls). Importantly, greater impairments were seen in lower limb compared to arm and trunk muscle groups. These findings may suggest that there should be greater consideration of muscle health in functionally relevant lower limb muscle groups.

Item Type:	Journal article
Publication Title:	Experimental Physiology
Creators:	Quinlan, J.I., Dhaliwal, A., Williams, F.R., Allen, S.L., Choudhary, S., Rowlands, A., Breen, L., Lavery, G.G., Lord, J.M., Elsharkawy, A.M., Armstrong, M.J. and Greig, C.A.
Publisher:	Wiley
Date:	August 2023
Volume:	108
Number:	8
ISSN:	0958-0670
Identifiers:	Number Type 10.1113/ep091157 DOI 2554548 Other
Rights:	© 2023 The Authors. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Divisions:	Schools > School of Science and Technology
Record created by:	Jeremy Silvester
Date Added:	09 Jan 2026 10:35
Last Modified:	09 Jan 2026 10:35
URI:	https://irep.ntu.ac.uk/id/eprint/55001

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