{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:03:19Z","timestamp":1785369799150,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,10,5]],"date-time":"2019-10-05T00:00:00Z","timestamp":1570233600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Advanced liver disease is associated with a persistent inflammatory state, derived from abnormal bacterial translocation from the gut, which may contribute to the development of sarcopenia in cirrhosis. We aim to document the association of chronic inflammation and bacterial translocation with the presence of sarcopenia in cirrhosis. We prospectively followed cirrhotic patients aged 18\u201370 years with medically refractory ascites at a single tertiary care center in Toronto, Canada. The baseline data included patient demographic variables, the presence of bacterial DNA in serum\/ascitic fluid, systemic inflammatory response syndrome (SIRS) status, and nutritional assessment. Thirty-one patients were enrolled, 18 (58.1%) were sarcopenic, 9 (29%) had bacterial DNA in serum and ascites fluid. The mean MELD score was 11.5 \u00b1 4.0 (6\u201323). Sarcopenic and non-sarcopenic patients did not differ significantly in their baseline MELD scores, caloric intake, resting energy expenditure, the incidence of bacterial translocation, or SIRS. While sarcopenia was not linked to increased hospital admissions or death, it was strongly associated with increased episodes of acute kidney injury (3 vs. 0, p = 0.05). This pilot study did not demonstrate an association between sarcopenia and SIRS or bacterial translocation. These results should be confirmed in future larger studies, encompassing a greater number of chronic inflammation events and quantifying levels of bacterial DNA.<\/jats:p>","DOI":"10.3390\/nu11102379","type":"journal-article","created":{"date-parts":[[2019,10,7]],"date-time":"2019-10-07T03:34:01Z","timestamp":1570419241000},"page":"2379","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of Bacterial Translocation on Sarcopenia in Patients with Decompensated Cirrhosis"],"prefix":"10.3390","volume":"11","author":[{"given":"Cynthia","family":"Tsien","sequence":"first","affiliation":[{"name":"Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada"},{"name":"Department of Medicine, the Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilia","family":"Antonova","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Such","sequence":"additional","affiliation":[{"name":"Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE"},{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8828-6888","authenticated-orcid":false,"given":"Irma","family":"Garcia-Martinez","sequence":"additional","affiliation":[{"name":"CIBERehd Hospital general Universitario de Alicante, 03010 Alicante, Spain"},{"name":"Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON M5G 2C4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.nut.2014.07.005","article-title":"Sarcopenia impairs prognosis of patients with liver cirrhosis","volume":"31","author":"Hanai","year":"2015","journal-title":"Nutrition"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1002\/lt.23495","article-title":"Severe muscle depletion in patients on the liver transplant wait list: Its prevalence and independent prognostic value","volume":"18","author":"Tandon","year":"2012","journal-title":"Liver Transpl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s11011-012-9365-z","article-title":"Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: Results of a prospective study","volume":"28","author":"Merli","year":"2013","journal-title":"Metabol. Brain Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8061","DOI":"10.3748\/wjg.v20.i25.8061","article-title":"Clinical relevance of sarcopenia in patients with cirrhosis","volume":"20","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.cgh.2011.08.028","article-title":"Muscle wasting is associated with mortality in patients with cirrhosis","volume":"10","author":"Prado","year":"2012","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jamcollsurg.2010.03.039","article-title":"Sarcopenia and post-liver transplant mortality","volume":"211","author":"Englesbe","year":"2010","journal-title":"J. Am. Coll. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1002\/hep.510290531","article-title":"Macronutrient preference, dietary intake, and substrate oxidation among stable cirrhotic patients","volume":"29","author":"Davidson","year":"1999","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1152\/japplphysiol.01042.2012","article-title":"Sarcopenia and a physiologically low respiratory quotient in patients with cirrhosis: A prospective controlled study","volume":"114","author":"Glass","year":"2013","journal-title":"J. Appl. Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1002\/hep.27717","article-title":"Branched chain amino acid supplementation in the skeletal muscle of alcoholic cirrhosis","volume":"61","author":"Tsien","year":"2015","journal-title":"Hepatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF03654825","article-title":"Potential mechanisms underlying the role of chronic inflammation in age-related muscle wasting","volume":"24","author":"Jo","year":"2012","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_11","first-page":"301","article-title":"The role and indications of albumin in advanced liver disease","volume":"82","author":"Zaccherini","year":"2019","journal-title":"Acta Gastroenterol. Belg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1128\/iai.23.2.403-411.1979","article-title":"Translocation of certain indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other organs in a gnotobiotic mouse model","volume":"23","author":"Berg","year":"1979","journal-title":"Infect. Immun."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1002\/hep.23918","article-title":"Bacterial DNA translocation is associated with systemic circulatory abnormalities and intrahepatic endothelial dysfunction in patients with cirrhosis","volume":"52","author":"Bellot","year":"2010","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/S0168-8278(00)00013-1","article-title":"Bacterial translocation of enteric organisms in patients with cirrhosis","volume":"34","author":"Cirera","year":"2001","journal-title":"J Hepatal."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1016\/j.amjmed.2005.10.049","article-title":"Inflammatory markers and loss of muscle mass (sarcopenia) and strength","volume":"119","author":"Schaap","year":"2006","journal-title":"Am. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.3389\/fphys.2017.01045","article-title":"The role of inflammation in age-related sarcopenia","volume":"8","author":"Dalle","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1002\/hep.22564","article-title":"Serum and ascitic fluid bacterial DNA: A new independent prognostic factor in noninfected patients with cirrhosis","volume":"48","author":"Zapater","year":"2008","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1111\/j.1478-3231.2010.02272.x","article-title":"Refractory ascites: Pathogenesis, definition and therapy of a severe complication in patients with cirrhosis","volume":"30","author":"Salerno","year":"2010","journal-title":"Liver Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1002\/bjs.1800600817","article-title":"Transection of the oesophagus for bleeding oesophageal varices","volume":"60","author":"Pugh","year":"1973","journal-title":"Br. J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1053\/he.2000.5852","article-title":"A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts","volume":"31","author":"Malinchoc","year":"2000","journal-title":"Hepatology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1053\/jhep.2002.33715","article-title":"Detection and identification of bacterial DNA in patients with cirrhosis and culture-negative, nonneutrocytic ascites","volume":"36","author":"Such","year":"2002","journal-title":"Hepatology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1002\/hep.22083","article-title":"Bacterial DNA in patients with cirrhosis and noninfected ascites mimics the soluble immune response established in patients with spontaneous bacterial peritonitis","volume":"47","author":"Frances","year":"2008","journal-title":"Hepatology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1001\/jama.1995.03520260039030","article-title":"The natural history of the systemic inflammatory response syndrome (SIRS)","volume":"273","author":"Pittet","year":"1995","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1177\/014860718701100108","article-title":"What is subjective global assessment of nutritional status?","volume":"11","author":"Detsky","year":"1987","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1093\/ajcn\/41.4.810","article-title":"Assessment of fat-free mass using bioelectrical impedance measurements of the human body","volume":"41","author":"Lukaski","year":"1985","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1038\/sj.ejcn.1600364","article-title":"and the EURODIAB IDDM Complications Study Group. Repeatability of three-day dietary records in the EURODIAB IDDM Complications Study","volume":"51","author":"Toeller","year":"1997","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1093\/ajcn\/34.11.2540","article-title":"New norms of upper limb fat and muscle areas for assessment of nutritional status","volume":"34","author":"Frisancho","year":"1981","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1177\/0148607115597666","article-title":"Predictive equations are inaccurate in the estimation of the resting energy expenditure of children with end-stage liver disease","volume":"41","author":"Carpenter","year":"2017","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1136\/gutjnl-2011-301255","article-title":"Acute kidney injury in decompensated cirrhosis","volume":"62","author":"Tsien","year":"2013","journal-title":"Gut"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/hep.27210","article-title":"Hepatic encephalopathy in chronic liver disease: 2014 Practice guideline by the American Association for the study of liver diseases and the European Association for the Study of the liver","volume":"60","author":"Vilstrup","year":"2015","journal-title":"Hepatology"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Carey, E.J., Lai, J.C., Sonnenday, C., Tapper, E.B., Tandon, P., Duarte-Rojo, A., Dunn, M.A., Tsien, C., Kallwitz, E.R., and Ng, V. (2019). A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation. Hepatology.","DOI":"10.1002\/hep.30828"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1172\/JCI111142","article-title":"Nature and quantity of fuels consumed in patients with alcoholic cirrhosis","volume":"72","author":"Owen","year":"1983","journal-title":"J. Clin. Investig."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.cld.2011.12.009","article-title":"Malnutrition in cirrhosis: Contribution and consequences of sarcopenia on metabolic and clinical responses","volume":"16","author":"Periyalwar","year":"2012","journal-title":"Clin. Liver Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"434","DOI":"10.3389\/fphys.2017.00434","article-title":"Targeting inflammation and downstream protein metabolism in sarcopenia: A brief up-dated description of concurrent exercise and leucine-based multimodal intervention","volume":"8","author":"Xia","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1152\/physiol.00044.2010","article-title":"mTor signaling in skeletal muscle during sepsis and inflammation: Where does it all go wrong?","volume":"26","author":"Frost","year":"2011","journal-title":"Physiology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.jnutbio.2009.01.005","article-title":"Presence of low-grade inflammation impaired postprandial stimulation of muscle protein synthesis in old rats","volume":"21","author":"Balage","year":"2010","journal-title":"J. Nutr. Biochem."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jhep.2005.10.013","article-title":"Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies","volume":"44","author":"Pagliaro","year":"2006","journal-title":"J. Hepatol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/10\/2379\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:27:48Z","timestamp":1760189268000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/10\/2379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,5]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10]]}},"alternative-id":["nu11102379"],"URL":"https:\/\/doi.org\/10.3390\/nu11102379","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,5]]}}}