Myostatin as a Marker of Reduced Muscle Mass in Children and Adolescents with Chronic Liver Disease

Abstract Background Sarcopenia is defined as a decrease in muscle mass, and is a reliable marker of nutritional status of patients with chronic diseases. Multiple factors contribute to malnutrition in chronic liver disease (CLD), such as impaired absorption and/or digestion, increased metabolic demands, anorexia, and decreased oral intake. Changes due to liver cirrhosis are considered potential disruptors of the balance of protein anabolism and catabolism which is a characteristic feature of Sarcopenia. Aim of the Work to assess the muscle mass in CLD pediatric patients and evaluate myostatin as a biomarker of sarcopenia in CLD pediatric patients and its association with muscle mass. Patients and Methods The study was conducted at the hepatology and nutrition clinics, of Ain Shams Children`s Hospital. It included 42 (20 male and 22 female) CLD patients and 45(26 male and 19 female) healthy controls aging between 2 and 18 years during the period from August 2021 to January 2022. They were subjected to full history taking, clinical evaluation, anthropometric measurements including weight, height, mid upper arm circumference(MUAC) and body mass index(BMI), assessment of body composition and measurement of serum myostatin. Results The prevalence of malnutrition in the CLD patients was significantly higher than the controls with p value<0.001 and it was as follow: 50% had abnormal weight, 42.85%were stunted and 42.85% had abnormal BMI. Although the prevalence of malnutrition in the cases detected by MUAC (in age group 2-5years) was 33.33%, yet this was not statistically significant compared to healthy control with p value 0.329. As regards the lean muscle mass measured by body composition scale, we found that the prevalence of decreased lean muscle mass was 57.58% in the cases which was significantly higher than the controls with p value<0.001. Our study showed that CLD patients had significantly higher serum myostatin level with median of 757ng/mL and range of (450-825ng/mL) in comparison to median of 120ng/mL and range of (100-140ng/mL) in healthy controls. There was a negative but non-significant correlation between the serum myostatin and decreased lean muscle mass in the cases with p value 0.253 and r -0.205. Conclusion Malnutrition is prevalent in children with CLD and decreased lean muscle mass is significantly evident. Serum myostatin level is significantly higher in patients with CLD compared to healthy controls.