Comparison of the ability between dual-energy X-ray absorptiometry and bioelectrical impedance analysis for diagnosing low skeletal muscle mass and sarcopenia in patients with chronic liver disease

Background and aim: Sarcopenia and osteoporosis adversely impact the clinical outcomes of patients with chronic liver disease (CLD). The Japan Society of Hepatology (JSH) sarcopenia criteria utilize bioelectrical impedance analysis (BIA) for assessing muscle mass rather than dual-energy X-ray absorptiometry (DXA), which can simultaneously diagnose these comorbidities. We investigated the correlations and interchangeability between the appendicular skeletal muscle mass index (ASMI) values determined using BIA and DXA and evaluated the diagnostic ability of DXA for sarcopenia and osteosarcopenia in patients with CLD.

Methods: This cross-sectional study included 173 patients with CLD. Sarcopenia was defined as low ASMI_BIA according to the JSH and Asian Working Group for Sarcopenia (AWGS) criteria (ASMI_{BIA cutoff}) or low ASMI_DXA according to the AWGS criteria (ASMI_{DXA cutoff}) and low handgrip strength. For women, a provisional cutoff value was set for ASMI_DXA using the ASMI_{BIA cutoff} (ASMI_{DXA-altered cutoff}).

Results: We found that ASMI_BIA and ASMI_DXA were significantly correlated (r = 0.921; P < 0.001). The Bland-Altman plots demonstrated substantial agreement between ASMI_BIA and ASMI_DXA, with a mean difference of 0.0116 kg/m². The prevalence rates of sarcopenia and osteosarcopenia diagnosed using the ASMI_{BIA cutoff} were 26.0% and 17.3%, respectively. The kappa coefficients for the prevalence of sarcopenia and osteosarcopenia were 0.759 and 0.775 between ASMI_{BIA cutoff} and ASMI_{DXA cutoff} and 0.780 and 0.806 between ASMI_{BIA cutoff} and ASMI_{DXA-altered cutoff}, respectively.

Conclusions: The utilization of DXA can facilitate the comprehensive assessment and management of musculoskeletal comorbidities in patients with CLD.