Low serum Manganese as a noninvasive marker predicting the presence of myosteatosis among hospitalized patients with cirrhosis

Emerging evidence elaborates on a close connection between trace elements and muscular abnormalities, mostly focusing on sarcopenia. We hypothesized an association between concentrations of serum trace elements and myosteatosis, given its more pronounced clinical implication relative to sarcopenia but a paucity of data in patients with cirrhosis. Consecutive patients were hospitalized for cirrhosis-associated complications. Serum trace elements (zinc, copper, manganese, magnesium, calcium and iron) were measured by inductively coupled plasma mass spectrometry. The presence of myosteatosis was defined according to CT-demarcated intramuscular adipose tissue content. In total, 295 cirrhotic patients were analyzed with a median age of 63 years and 53.6% male. Among them, 42 patients presented with myosteatosis (14.2%) and concomitant higher MELD-Na and triglyceride concentrations, lower neutrophil counts and serum manganese concentrations (all P <0.05). No differences were found regarding other five trace elements in patients with versus without myosteatosis. The median serum manganese concentrations were 1.16 μg/L, and this population was categorized into high-Mn and low-Mn groups. The proportion of myosteatosis was significantly lower in high-Mn group than that in low-Mn group (8.1% versus 20.4%, P <0.001). Univariable binary logistic regression indicated that low-Mn was associated with myosteatosis (OR: 2.906, 95% CI: 1.424, 5.932, P = 0.003) in the context of cirrhosis. This result was validated according to multivariable analysis by adjusting for confounding factors. In conclusion, low serum manganese can be predictive of myosteatosis, a novel muscular abnormality representing more clinical relevance and close relation to inferior outcomes among cirrhosis.