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Review
. 2025 Aug 9;17(16):2589.
doi: 10.3390/nu17162589.

Assessment of Sarcopenia in Patients with Liver Cirrhosis-A Literature Review

Dorotea Bozic  1 , Bisera Mamic  2 , Iva Peric  3 , Ivona Bozic  4 , Ivan Zaja  1   5 , Tomislav Ivanovic  6 , Ana Gugic Ratkovic  7 , Ivica Grgurevic  8   9   10
Affiliations
Review

Assessment of Sarcopenia in Patients with Liver Cirrhosis-A Literature Review

Dorotea Bozic et al. Nutrients. .

Abstract

Sarcopenia refers to a disorder involving the gradual and overall reduction in skeletal muscle mass and physical capability. It occurs in over one-third of individuals with liver cirrhosis and serves as an independent predictor of increased mortality risk. Assessment of sarcopenia is necessary in all patients with liver cirrhosis, as recommended by the European Association for the Study of the Liver (EASL) and the European Society for Clinical Nutrition and Metabolism (ESPEN). The evaluation of muscle mass can be performed using several validated methods such as the multislice computed tomography (MSCT), abdominal magnetic resonance imaging (MRI), dual X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), or muscle ultrasound. Assessment of muscle function encompasses measurements of both muscle strength and physical performance. Sarcopenia has a significant negative impact on the course of the disease, quality of life and outcomes of patients with liver cirrhosis. Considering the global healthcare impact and the significant influence on the course of disease, characteristics of simplicity, swiftness, safety, availability, reproducibility, and diagnostic accuracy are certainly the key factors to consider when choosing the proper diagnostic method for nutritional assessment. The aim of this review is to analyze the pathophysiological mechanisms underlying muscle mass loss in patients with liver cirrhosis, as well as to assess strengths and limitations of the methods currently in use to diagnose sarcopenia.

Keywords: BIA; L3-SMI; liver cirrhosis; muscle thickness; sarcopenia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Scheme 1
Scheme 1
A simplified Royal Free Hospital Nutritional Prioritizing Tool.
Figure 1
Figure 1
L3-SMI in the assessment of sarcopenia using ImageJ software version 1.48: outer (A) and inner (B) outline of muscles at the third lumbar section. L3-SMI: skeletal muscle index at the level of the third lumbar vertebra.
Figure 2
Figure 2
BIA parameters in the assessment of sarcopenia include SMI derived from SMM (SMM/height2) and the PA. This patient (SMI 8.29 kg/m2, PA 5.0°) would be classified as sarcopenic.
Figure 3
Figure 3
Ultrasound assessment of the quadriceps femoris muscle indicates (A) the absence of sarcopenia in a female patient with liver cirrhosis (CSA 4.18 cm2) and (B) the presence of sarcopenia in another female with liver cirrhosis (quadriceps thickness/height 1.56 cm/m).
Figure 4
Figure 4
Ultrasound assessment of the quadriceps femoris muscle indicates severe sarcopenia in this male patient with alcoholic liver cirrhosis (quadriceps femoris thickness/height 1.05 cm/m and CSA 2.86 cm2).
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