Clinical Overview of Sarcopenia, Frailty, and Malnutrition in Patients With Liver Cirrhosis

Abstract

Sarcopenia, frailty, and malnutrition in patients with liver cirrhosis are commonly observed and are associated with higher long-term mortality. Therefore, recognizing patients with increased nutritional risk and providing recommended interventions are essential in the long- and short-term management of cirrhosis, especially as alcoholic and non-alcoholic fatty liver disease continues to rise. Various assessment tools are available to gauge frailty and malnutrition but are infrequently used. Given the global burden of liver cirrhosis, periodic screening for malnutrition, sarcopenia, and frailty is desperately needed as it improves liver transplantation outcomes. Necessary steps include addressing knowledge gaps in professional healthcare workers and patients and using standardized assessment tools to counteract physical deconditioning as early as possible. One potential method for assessing sarcopenia involves using computed tomography to evaluate the skeletal muscle index. Regarding frailty, useful tools for longitudinal assessment include the liver frailty index and the Karnofsky performance status. Addressing educational requirements related to malnutrition involves seeking guidance from dieticians, who can provide counseling on achieving sufficient calorie and protein intake to combat the progression of malnutrition.

The Influence of Urbanization on the Patterns of Hepatocellular Carcinoma Mortality From 1999 to 2020

“…Additional protection arises from the liver-specific gene CYP39A1, which demonstrates hepatoprotective properties and is more prevalent in females [ 27 ]. Overall, the factors contributing to the difference in HCC development between sexes are not fully understood and are likely a result of a complex interplay involving epigenetic influences, lifestyle, diet, behavioral factors, and hormonal differences [ 2 , 28 ].…”

Screening and assessment of malnutrition in patients with liver cirrhosis

“…In patients with cirrhosis, malnutrition is characterized by depletion of skeletal muscle and adipose tissue mass, with the main nutritional consequences of the loss of skeletal muscle mass ( 79 ). Sarcopenia can be measured by handgrip strength (HGS) in addition to the Skeletal Muscle Index (SMI) ( 41 ).…”

“…Although it is costly to perform CT specifically to calculate SMI, patients are exposed to unnecessary radiation. Notably, patients with cirrhosis often undergo CT for other reasons (e.g., to screen for hepatocellular carcinoma), so this approach is clinically feasible; and SMI values calculated from thoracic spine 12 (T12) levels also showed a correlation with mortality ( 41 , 79 ). Therefore, CT images at the T12 level can be used to calculate SMI for those patients who do not have abdominal CT. A review indicated that ultrasound testing for sarcopenia in patients with advanced liver disease is safe, feasible, and shows good correlation with gold standard measurements of sarcopenia and can be used as a valid tool in daily practice ( 85 ).…”