Research Article

Myosteatosis and Frailty Factors associated with the occurrence of Complications in Cirrhotic patients: MYOFACC study

Bernard El Khoury*, S Khazaka, N Chalhoub, F Abi Habib, L Saba, Y Sarkis, K Honein, R Sayegh, R Slim and C Yaghi

Published: 17 October, 2023 | Volume 7 - Issue 1 | Pages: 019-027

Background and aim: Cirrhosis leads to sarcopenia and to life-threatening complications in decompensated stages. The objective of this study is to show the impact of the loss of muscle mass and function on hepatic decompensations. 
Methods: Our study compares a group of cirrhotic patients with controls matched with the same sex and age. A questionnaire was created to collect demographic, anthropometric, and cirrhosis characteristics. Several CT scan sections were analyzed and the average measurements have been grouped into tertiles to estimate the impact on cirrhotic complications.
Results: Our study included 33 controls and 33 cirrhotic patients of which 59.4% had NASH. Anthropometric characteristics were similar in cirrhotics men and women. Grip strength was significantly lower in cirrhotic men. Using the skeletal muscle index we found 39.39% of cirrhotic patients were sarcopenic mostly men 84.61%. In Cirrhotic men, the density of the psoas and paravertebral muscles was lower than in controls. In women psoas and paravertebral muscle areas were comparable and the total muscle surface in cirrhotic patients was higher. There was a negative correlation between this surface and the density of the psoas (r = -0.293 p = 0.017) indicating the presence of myosteatosis in women. Analysing tertile groups showed a significantly higher incidence of complications related to liver disease and liver failure in patients with the psoas and paravertebral muscle density in the lowest tertile and in the frail population according to the frailty index.
Conclusion: Cirrhotic patients have myosteatosis and sarcopenia associated with a higher incidence of complications related to hepatic failure.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001041 Cite this Article Read Full Article PDF


Frailty; Sarcopenia; Liver cirrhosis; Tomography; X-ray computed; Adiposity; Liver failure


  1. Ebadi M, Tsien C, Bhanji RA, Dunichand-Hoedl AR, Rider E, Motamedrad M, Mazurak VC, Baracos V, Montano-Loza AJ. Myosteatosis in Cirrhosis: A Review of Diagnosis, Pathophysiological Mechanisms and Potential Interventions. Cells. 2022 Apr 4;11(7):1216. doi: 10.3390/cells11071216. PMID: 35406780; PMCID: PMC8997850.
  2. Feng H, Wang X, Mao L, Yu Z, Cui B, Lin L, Hui Y, Zhao X, Xu X, Fan X, Wang B, Yu Q, Jiang K, Sun C. Relationship between sarcopenia/myosteatosis and frailty in hospitalized patients with cirrhosis: a sex-stratified analysis. Ther Adv Chronic Dis. 2021 Jul 27;12:20406223211026996. doi: 10.1177/20406223211026996. PMID: 34377386; PMCID: PMC8320564.
  3. Bunchorntavakul C, Reddy KR. Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis. Aliment Pharmacol Ther. 2020 Jan;51(1):64-77. doi: 10.1111/apt.15571. Epub 2019 Nov 8. PMID: 31701570.
  4. Wijarnpreecha K, Werlang M, Panjawatanan P, Kroner PT, Cheungpasitporn W, Lukens FJ, Pungpapong S, Ungprasert P. Association between sarcopenia and hepatic encephalopathy: A systematic review and meta-analysis. Ann Hepatol. 2020 May-Jun;19(3):245-250. doi: 10.1016/j.aohep.2019.06.007. Epub 2019 Jul 13. PMID: 31422030.
  5. Farkas ZC, Rashid T, Chen YS, Siddiqui TM, Yandrapalli S, Frager S, Aronow WS, Bodin R, Maddineni S. The correlation between sarcopaenia and post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy: a single-institution review. Arch Med Sci Atheroscler Dis. 2019 May 27;4:e89-e93. doi: 10.5114/amsad.2019.85380. PMID: 31211275; PMCID: PMC6554751.
  6. Sinclair M, Gow PJ, Grossmann M, Angus PW. Review article: sarcopenia in cirrhosis--aetiology, implications and potential therapeutic interventions. Aliment Pharmacol Ther. 2016 Apr;43(7):765-77. doi: 10.1111/apt.13549. Epub 2016 Feb 5. PMID: 26847265.
  7. Santos LAA, Lima TB, Ietsugu MDV, Nunes HRC, Qi X, Romeiro FG. Anthropometric measures associated with sarcopenia in outpatients with liver cirrhosis. Nutr Diet. 2019 Nov;76(5):613-619. doi: 10.1111/1747-0080.12523. Epub 2019 Mar 14. PMID: 30869199.
  8. Tandon P, Low G, Mourtzakis M, Zenith L, Myers RP, Abraldes JG, Shaheen AA, Qamar H, Mansoor N, Carbonneau M, Ismond K, Mann S, Alaboudy A, Ma M. A Model to Identify Sarcopenia in Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2016 Oct;14(10):1473-1480.e3. doi: 10.1016/j.cgh.2016.04.040. Epub 2016 May 14. Erratum in: Clin Gastroenterol Hepatol. 2022 Jun;20(6):1423. PMID: 27189915.
  9. Giusto M, Lattanzi B, Albanese C, Galtieri A, Farcomeni A, Giannelli V, Lucidi C, Di Martino M, Catalano C, Merli M. Sarcopenia in liver cirrhosis: the role of computed tomography scan for the assessment of muscle mass compared with dual-energy X-ray absorptiometry and anthropometry. Eur J Gastroenterol Hepatol. 2015 Mar;27(3):328-34. doi: 10.1097/MEG.0000000000000274. PMID: 25569567.
  10. Paternostro R, Lampichler K, Bardach C, Asenbaum U, Landler C, Bauer D, Mandorfer M, Schwarzer R, Trauner M, Reiberger T, Ferlitsch A. The value of different CT-based methods for diagnosing low muscle mass and predicting mortality in patients with cirrhosis. Liver Int. 2019 Dec;39(12):2374-2385. doi: 10.1111/liv.14217. Epub 2019 Sep 11. PMID: 31421002; PMCID: PMC6899596.
  11. Bhanji RA, Moctezuma-Velazquez C, Duarte-Rojo A, Ebadi M, Ghosh S, Rose C, Montano-Loza AJ. Myosteatosis and sarcopenia are associated with hepatic encephalopathy in patients with cirrhosis. Hepatol Int. 2018 Jul;12(4):377-386. doi: 10.1007/s12072-018-9875-9. Epub 2018 Jun 7. PMID: 29881992.
  12. Mullie L, Afilalo J. CoreSlicer: a web toolkit for analytic morphomics. BMC Med Imaging. 2019 Feb 11;19(1):15. doi: 10.1186/s12880-019-0316-6. PMID: 30744586; PMCID: PMC6371488.
  13. Tantai X, Liu Y, Yeo YH, Praktiknjo M, Mauro E, Hamaguchi Y, Engelmann C, Zhang P, Jeong JY, van Vugt JLA, Xiao H, Deng H, Gao X, Ye Q, Zhang J, Yang L, Cai Y, Liu Y, Liu N, Li Z, Han T, Kaido T, Sohn JH, Strassburg C, Berg T, Trebicka J, Hsu YC, IJzermans JNM, Wang J, Su GL, Ji F, Nguyen MH. Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis. J Hepatol. 2022 Mar;76(3):588-599. doi: 10.1016/j.jhep.2021.11.006. Epub 2021 Nov 14. PMID: 34785325.
  14. Hou L, Deng Y, Fan X, Zhao T, Cui B, Lin L, Hou J, Mao L, Zhao W, Jiang K, Wang B, Zhang J, Sun C. A Sex-Stratified Prognostic Nomogram Incorporating Body Compositions for Long-Term Mortality in Cirrhosis. JPEN J Parenter Enteral Nutr. 2021 Feb;45(2):403-413. doi: 10.1002/jpen.1841. Epub 2020 May 2. PMID: 32359094.
  15. Meister FA, Bednarsch J, Amygdalos I, Boecker J, Strnad P, Bruners P, Lang SA, Ulmer TF, Heij L, Santana DAM, Liu WJ, Lurje G, Neumann UP, Czigany Z. Various myosteatosis selection criteria and their value in the assessment of short- and long-term outcomes following liver transplantation. Sci Rep. 2021 Jun 28;11(1):13368. doi: 10.1038/s41598-021-92798-5. PMID: 34183733; PMCID: PMC8239038.
  16. Gleason LJ, Benton EA, Alvarez-Nebreda ML, Weaver MJ, Harris MB, Javedan H. FRAIL Questionnaire Screening Tool and Short-Term Outcomes in Geriatric Fracture Patients. J Am Med Dir Assoc. 2017 Dec 1;18(12):1082-1086. doi: 10.1016/j.jamda.2017.07.005. Epub 2017 Aug 31. PMID: 28866353; PMCID: PMC6611671.
  17. Buchard B, Boirie Y, Cassagnes L, Lamblin G, Coilly A, Abergel A. Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice? Nutrients. 2020 Jan 9;12(1):186. doi: 10.3390/nu12010186. PMID: 31936597; PMCID: PMC7020005.
  18. Dhaliwal A, Williams FR, El-sherif O, Armstrong MJ. Sarcopenia in Liver Transplantation: an Update. Curr Hepatol Rep. 2020 Jun; 19(2):128–37.
  19. Golse N, Bucur PO, Ciacio O, Pittau G, Sa Cunha A, Adam R, Castaing D, Antonini T, Coilly A, Samuel D, Cherqui D, Vibert E. A new definition of sarcopenia in patients with cirrhosis undergoing liver transplantation. Liver Transpl. 2017 Feb;23(2):143-154. doi: 10.1002/lt.24671. Epub 2017 Jan 6. PMID: 28061014.
  20. Nishikawa H, Enomoto H, Ishii A, Iwata Y, Miyamoto Y, Ishii N, Yuri Y, Hasegawa K, Nakano C, Nishimura T, Yoh K, Aizawa N, Sakai Y, Ikeda N, Takashima T, Takata R, Iijima H, Nishiguchi S. Elevated serum myostatin level is associated with worse survival in patients with liver cirrhosis. J Cachexia Sarcopenia Muscle. 2017 Dec;8(6):915-925. doi: 10.1002/jcsm.12212. Epub 2017 Jun 18. PMID: 28627027; PMCID: PMC5700437.
  21. Sinclair M, Grossmann M, Angus PW, Hoermann R, Hey P, Scodellaro T, Gow PJ. Low testosterone as a better predictor of mortality than sarcopenia in men with advanced liver disease. J Gastroenterol Hepatol. 2016 Mar;31(3):661-7. doi: 10.1111/jgh.13182. PMID: 26414812.
  22. Kang SH, Jeong WK, Baik SK, Cha SH, Kim MY. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle. 2018 Oct;9(5):860-870. doi: 10.1002/jcsm.12333. PMID: 30371017; PMCID: PMC6204582.
  23. Wang S, Whitlock R, Xu C, Taneja S, Singh S, Abraldes JG, Burak KW, Bailey RJ, Lai JC, Tandon P. Frailty is associated with increased risk of cirrhosis disease progression and death. Hepatology. 2022 Mar;75(3):600-609. doi: 10.1002/hep.32157. Epub 2021 Dec 5. PMID: 34528267.
  24. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. 2019 Jan;70(1):172-193. doi: 10.1016/j.jhep.2018.06.024. Epub 2018 Aug 23. PMID: 30144956; PMCID: PMC6657019.


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