23895a2a557938e54ea91942fd173d3c medsci-13-00030.pdf a54fed5620688b606f15b4b8f6b5bab64917b33e medsci-13-00030.pdf e9c10f620223771b7681640cbc3e8a352e2edfc5dc2c1ccc4fa10ba93a4d6535 medsci-13-00030.pdf Title: Treatment of Vitamin D Deficiency in Decompensated Patients with Cirrhosis Is Associated with Improvement in Frailty Subject: Background/aim: Frailty is increasingly recognized as a relevant prognostic factor in patients with cirrhosis, regardless of liver failure. Vitamin D deficiency is frequent in these patients and has been related to frailty and sarcopenia, but the impact of its supplementation on frailty in cirrhosis is unknown. The aim was to evaluate the effect of vitamin D supplementation on frailty in patients with decompensated cirrhosis and vitamin D deficiency or insufficiency. Methods: We included patients with cirrhosis who had vitamin D deficiency or insufficiency following their hospitalization for acute decompensation. Vitamin D was supplemented according to current recommendations, as were other micronutrients if necessary. Patients were followed for one year to evaluate changes at 6 and 12 months in frailty (Fried frailty index), health-related quality of life (SF-36, CLDQ) and mood (HADS). Body composition was assessed by DXA at baseline and at 12 months. Results: We included 39 patients, 27 of whom reached the 6-month follow-up. Serum vitamin D increased at 6 and 12 months (p < 0.001 compared to baseline). Fried frailty index improved at the 6-month visit (p = 0.004), and handgrip strength improved at 6 (p = 0.001) and 12 (p = 0.002) months, similarly in women and men. At 12 months, we observed an increase in body mass index, right arm lean mass and total fat mass. Conclusions: A multifactorial nutritional intervention, especially vitamin D supplementation after discharge in decompensated, vitamin D-deficient patients with cirrhosis, was associated with an improvement in frailty, muscular strength and lean muscle mass. However, the increase in fat mass strengthens the recommendation for diet, exercise and weight supervision. Keywords: human; cirrhosis; frailty; sarcopenia; vitamin D Author: Raquel Díaz-Ruíz, Maria Poca, Eva Román, Berta Cuyàs, Irene Bañares, Ángela Morales, Elvira Hernández Martínez-Esparza, Rocío Panadero, Cristina Velasco, Marta Rapado-Castro, Irene Bretón, Rafael Bañares, German Soriano and Rita García-Martínez Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Thu Mar 13 07:40:45 2025 CET ModDate: Thu Mar 13 07:47:34 2025 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 18 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 771410 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WNWTFR+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 QOTCDY+URWPalladioL-Roma Type 1 Custom yes yes yes 16 0 RPMIRT+URWPalladioL-Bold Type 1 Custom yes yes yes 22 0 OCNPZU+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 DMTLJA+VnURWPalladioL Type 1 Custom yes yes yes 32 0 CZMDWU+CMSY10 Type 1 Builtin yes yes yes 61 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 72 0 NIIPIJ+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 86 0 NIIOIH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 89 0 NIIOII+PalatinoLinotype CID TrueType Identity-H yes yes yes 92 0 NIIOIJ+PalatinoLinotype TrueType WinAnsi yes yes no 98 0 NIIOIL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 101 0 NIIPEJ+PalatinoLinotype TrueType MacRoman yes yes no 104 0 NIIOIH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 132 0 NIIOIJ+PalatinoLinotype TrueType WinAnsi yes yes no 135 0 NIIOIL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 138 0 NIIPEJ+PalatinoLinotype TrueType MacRoman yes yes no 141 0 NIIOIH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 166 0 NIIOIJ+PalatinoLinotype TrueType WinAnsi yes yes no 169 0 NIIOIL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 172 0 NIIPEJ+PalatinoLinotype TrueType MacRoman yes yes no 175 0 OVNEXW+EURM10 Type 1 Builtin yes yes yes 185 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-11-21 04:25:12 CET RepresentationInformation: medsci-13-00030.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-11-20 14:27:17 CET Size: 771410 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 412 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Design Destination: subsection.2.1 Item: Title: Patients Destination: subsection.2.2 Item: Title: Treatment Destination: subsection.2.3 Item: Title: Anthropometric Assessments Destination: subsection.2.4 Item: Title: Frailty Destination: subsection.2.5 Item: Title: Incidence of Falls and Other Clinical Events Destination: subsection.2.6 Item: Title: Handgrip Muscular Strength Destination: subsection.2.7 Item: Title: Body Composition by Dual Energy X-Ray Absorptiometry (DXA) Destination: subsection.2.8 Item: Title: Health-Related Quality of Life (HRQoL) and Mood: SF-36, CLDQ and HADS Destination: subsection.2.9 Item: Title: Analytical Determinations Destination: subsection.2.10 Item: Title: Statistical Analysis Destination: subsection.2.11 Item: Title: Results Destination: section.3 Children: Item: Title: Frailty Destination: subsection.3.1 Item: Title: Handgrip Muscular Strength Destination: subsection.3.2 Item: Title: Mood and HRQoL Destination: subsection.3.3 Item: Title: Analytical Parameters Destination: subsection.3.4 Item: Title: Body Composition Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Treatment of Vitamin D Deficiency in Decompensated Patients with Cirrhosis Is Associated with Improvement in Frailty Author: Raquel Díaz-Ruíz, Maria Poca, Eva Román, Berta Cuyàs, Irene Bañares, Ángela Morales, Elvira Hernández Martínez-Esparza, Rocío Panadero, Cristina Velasco, Marta Rapado-Castro, Irene Bretón, Rafael Bañares, German Soriano and Rita García-Martínez Subject: Background/aim: Frailty is increasingly recognized as a relevant prognostic factor in patients with cirrhosis, regardless of liver failure. Vitamin D deficiency is frequent in these patients and has been related to frailty and sarcopenia, but the impact of its supplementation on frailty in cirrhosis is unknown. The aim was to evaluate the effect of vitamin D supplementation on frailty in patients with decompensated cirrhosis and vitamin D deficiency or insufficiency. Methods: We included patients with cirrhosis who had vitamin D deficiency or insufficiency following their hospitalization for acute decompensation. Vitamin D was supplemented according to current recommendations, as were other micronutrients if necessary. Patients were followed for one year to evaluate changes at 6 and 12 months in frailty (Fried frailty index), health-related quality of life (SF-36, CLDQ) and mood (HADS). Body composition was assessed by DXA at baseline and at 12 months. Results: We included 39 patients, 27 of whom reached the 6-month follow-up. Serum vitamin D increased at 6 and 12 months (p < 0.001 compared to baseline). Fried frailty index improved at the 6-month visit (p = 0.004), and handgrip strength improved at 6 (p = 0.001) and 12 (p = 0.002) months, similarly in women and men. At 12 months, we observed an increase in body mass index, right arm lean mass and total fat mass. Conclusions: A multifactorial nutritional intervention, especially vitamin D supplementation after discharge in decompensated, vitamin D-deficient patients with cirrhosis, was associated with an improvement in frailty, muscular strength and lean muscle mass. However, the increase in fat mass strengthens the recommendation for diet, exercise and weight supervision. 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