Original article Handgrip strength and lean mass are independently related to brain atrophy among alcoholics Lucía Romero-Acevedo a , Emilio Gonz  alez-Reimers a , M. Candelaria Martín-Gonz  alez a, * , Antonieta Gonz  alez-Díaz b , Geraldine Quintero-Platt a , Paula Reyes-Su  arez a , Daniel Martínez-Martínez a , Francisco Santolaria-Fern  andez a a Servicio de Medicina Interna, Universidad de La Laguna, Tenerife, Canary Islands, Spain b Servicio de Medicina Nuclear, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Canary Islands, Spain article info Article history: Received 26 December 2017 Accepted 8 June 2018 Keywords: Body composition Alcoholism Lean mass Fat mass Handgrip strength summary Background: In neurodegenerative disorders or in normal aging humans a relationship between muscle mass and/or performance and brain volume was observed, that is not dependent on age or other con- founding factors. The aim of the present study is to analyse the relationship between lean mass and handgrip strength in alcoholics, who frequently show brain and muscle atrophy. Methods: It was included 101 male patients aged 58.35 ± 11.59 years, and 44 controls, all of them workers of our hospital, drinkers of less than 20 g ethanol/day, of similar age. Patients and controls underwent dominant handgrip assessment with a Collins’ dynamometer, whole body composition analysis by densitometry, and brain computed tomography (CT) examination, with further calculation of several indices indicative of brain atrophy. Main Results: 1) Brain atrophy is a very common finding among alcoholics, both among cirrhotics and non-cirrhotics. 2) Alcoholics show a marked reduction in handgrip strength, and also in lean mass, especially at the arms and legs ebut not in the trunk, even if patients with ascites were excluded.3) There is a relationship between reduced lean mass and brain atrophy, and a close correlation between handgrip strength and brain atrophy, that is independent of age and liver function. 4) Total fat amount is not different among alcoholics and controls, but there are marked differences in fat distribution: alco- holics show less fat in arms, but more fat in trunk, so that if we calculate the peripheral fat/trunk fat index, marked differences were observed among alcoholics and controls. Neither total fat nor fat dis- tribution were related to brain atrophy. Conclusion: among alcoholics, as in other neurodegenerative conditions, there is a relationship between reduced lean mass and brain atrophy, and a close correlation between handgrip strength and brain at- rophy, that is independent of age, duration of ethanol consumption and liver function. © 2018 Published by Elsevier Ltd. 1. Introduction Chronic ethanol consumption is associated with both muscle wasting and protein-calorie malnutrition, characterized by a decrease in lean mass and fat mass and also Kwashiorkor-like features [1]. However, not all groups that have analysed this issue have reached similar results [2]. Some have reported preservation or increase in fat mass, especially at the trunk [3] (more markedly in some collectives such as African Americans [4] or women [5]), whereas others have pointed out that fat mass is decreased [6]. By contrast, there is general agreement that 40e60% of heavy alcoholics suffer from chronic myopathy, an entity that was described several decades ago [7] and that is defined by muscle fiber atrophy (mainly type II fibers [8]) and weakness especially affecting proximal muscles. Alcoholic myopathy depends on an imbalance between protein synthesis and protein breakdown, with a possible contributory role of vitamin D deficiency and/or alter- ations in micronutrients and perhaps inflammation [9]. In recent times it has become progressively clear that muscle is a main source of several hormones and cytokines, functioning as an endocrine organ that exerts important systemic effects [10e12].A group of these so called myokines are active on the brain [13]. In addition, muscle activity may improve cerebral blood flow, decrease insulin resistance, and exert anti-inflammatory effects and thus may contribute to adequate brain performance [14,15]. On * Corresponding author. E-mail address: candemartin1983@gmail.com (M.C. Martín-Gonz alez). Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu https://doi.org/10.1016/j.clnu.2018.06.965 0261-5614/© 2018 Published by Elsevier Ltd. Clinical Nutrition xxx (2018) 1e8 Please cite this article in press as: Romero-Acevedo L, et al., Handgrip strength and lean mass are independently related to brain atrophy among alcoholics, Clinical Nutrition (2018), https://doi.org/10.1016/j.clnu.2018.06.965