Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://www.gastrores.org

Review

Volume 17, Number 2, April 2024, pages 53-63

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

Figures

Figure 1.
Figure 1. Algorithm in the assessment of sarcopenia, frailty, and malnutrition. This algorithm highlights the essential steps in assessing frailty, sarcopenia, and malnutrition in patients with liver cirrhosis. This flowchart illustrates only a selection of available assessment tools. We recommend regularly using the same tools to increase the likelihood of noticing subtle changes. Regular assessments are based on the patient’s clinical status and should be conducted at least annually. In case of decompensation or clinical deterioration, periodic reviews should be performed every 3 to 6 months in ambulatory clinics. For nutritional purposes, use dry weight-based body mass index and subtract weight depending on the amount of volume overload.
Figure 2.
Figure 2. Implications of malnutrition, sarcopenia, and frailty in the context of cirrhosis from multiple viewpoints.

Table

Table 1. A Summary of the Definitions for Sarcopenia, Frailty, and Malnutrition, as Well as the Screening Tools Available for Assessing These Conditions
 
ConditionDefinitionAvailable screening toolsGeneral recommendations
SarcopeniaA progressive and generalized skeletal muscle disorder associated with an increased likelihood of adverse outcomes including falls, fractures, disability, and mortality1) Skeletal muscle index (computed tomography scan at level L3); 2) Bioelectrical impedance analysis with phase angle measurement1) Screen for sarcopenia and frailty with available tools; 2) Determine the elements that contribute to malnutrition by assessing food insecurity via Hunger Vital signs
FrailtyA syndrome comprised of a cumulative decline in multiple physiological systems secondary to decreased physiologic reserve resulting in vulnerability and adverse outcomes1) Liver frailty index; 2) Karnofsky performance status; 3) Activity of daily living; 4) Short physical performance battery; 5) 6-min walk test1) Assess degree of physical (in)activity; 2) Liberalize diet if possible, consider enteral/parenteral routes if feasible; 3) Monitor objective measures of liver function (MELD 3.0, Child-Pugh-score); 4) Combination of aerobic and resistance exercises based on the frequency, intensity, time, and type principles
MalnutritionState of nutrition in which a deficiency of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form and function, and clinical outcome1) Royal-free hospital prioritizing tool (RFH-NPT); 2) Indirect calorimetry; 3) Hunger Vital signs