Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis: Sarcopenic obesity and myosteatosis in cirrhosis
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BACKGROUND AND AIMS: Obesity is frequently associated with cirrhosis, and cirrhotic patients may develop simultaneous loss of skeletal muscle and gain of adipose tissue, culminating in the condition of sarcopenic obesity. Additionally, muscle depletion is characterized by both a reduction in muscle size and increased proportion of muscular fat, termed myosteatosis. In this study, we aimed to establish the frequency and clinical significance of sarcopenia, sarcopenic obesity and myosteatosis in cirrhotic patients. METHODS: We analysed 678 patients with cirrhosis. Sarcopenia, sarcopenic obesity and myosteatosis were analysed by CT scan using the third lumbar vertebrae skeletal muscle and attenuation indexes, using previously validated gender-and body mass index-specific cutoffs. RESULTS: Patients were predominately men (n = 457, 67%), and cirrhosis aetiology was hepatitis C virus in 269 patients (40%), alcohol in 153 (23%), non-alcoholic steatohepatitis/cryptogenic in 96 (14%), autoimmune liver disease in 55 (8%), hepatitis B virus in 43 (6%), and others in 5 patients (1%). Sarcopenia was present in 292 (43%), 135 had sarcopenic obesity (20%) and 353 had myosteatosis (52%). Patients with sarcopenia (22 ± 3 vs. 95 ± 22 months, P < 0.001), sarcopenic obesity (22 ± 3 vs. 95 ± 22 months, P < 0.001), and myosteatosis (28 ± 5 vs. 95 ± 22 months, P < 0.001) had worse median survival than patients without muscular abnormalities. By multivariate Cox regression analysis, both sarcopenia [hazard ratio (HR) 2.00, 95% confidence interval (CI) 1.44-2.77, P < 0.001], and myosteatosis (HR 1.42, 95% CI 1.02-1.07, P = 0.04) were associated with mortality. CONCLUSIONS: Sarcopenia, sarcopenic obesity and myosteatosis are often present in patients with cirrhosis, and sarcopenia and myosteatosis are independently associated with a higher long-term mortality in cirrhosis.
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Obesity and sarcopenic obesity are risk factors for clinical decompensation and worsen prognosis.
“Obesity and sarcopenic obesity are risk factors for clinical decompensation and worsen prognosis.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [450]
The Introduction (page unavailable) describes obesity as a risk factor for clinical decompensation, citing earlier work. The Results section on survival (page unavailable) reports worse survival with sarcopenic obesity, but does not establish that it predicts clinical decompensation; it also reports similar survival for overweight–obese and normal-BMI patients. Thus the paper does not support applying both outcomes to both conditions. (LLM, conf=0.90)
Experimental — accuracy not yet measuredSarcopenic obesity occurs mainly in MASH-related cirrhosis and is found in 20-35% of individuals with cirrhosis pre-and-post liver transplant.
“Sarcopenic obesity, the state of decreased muscle mass in the setting of increased fat mass, occurs mainly in MASH-related cirrhosis and is found in 20 -35% of individuals with cirrhosis pre-and-post liver transplant.”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [450]
The Introduction defines sarcopenic obesity as muscle loss with adipose-tissue gain. The Results (Clinical and biochemical features; no page supplied) report it in 20% of patients evaluated before transplantation, but do not establish that it occurs mainly in MASH-related cirrhosis. The post-transplant Outcomes section reports that 17% of those who received a transplant had sarcopenic obesity; it does not establish a 20–35% prevalence after transplantation. (LLM, conf=0.88)
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- Authors
- Montano-Loza, A. J., Angulo, P., Meza-Junco, J., Prado, C. M. M., Sawyer, M. B., Beaumont, C., Esfandiari, N., Ma, M., & Baracos, V. E.
- Affiliations
- Division of Gastroenterology & Liver Unit; University of Alberta Hospital; Edmonton Alberta Canada
- University of Kentucky HealthCare (US)
- Department of Oncology; Cross Cancer Institute; Edmonton Alberta Canada
- University of Alberta (CA)
- Cross Cancer Institute (CA)
- Alberta Hospital Edmonton (CA)
- Venue
- Journal of Cachexia Sarcopenia and Muscle
- Publisher
- Wiley
- Published
- 2015-06-09
- Volume
- 7
- Issue
- 2
- Pages
- 126-135
- ISSN
- 2190-5991 (ISSN-L)
- PMC
- PMC4864157
- OpenAlex
- W1490232555
- Cited by
- 512
- References
- 43
- Citations by year
- 2026: 29 · 2025: 34 · 2024: 67 · 2023: 67 · 2022: 78 · 2021: 53 · 2020: 48 · 2019: 53 · 2018: 48 · 2017: 26 · 2016: 4 · 2015: 3 · 2014: 1
- FWCI
- 19.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Cachexia Sarcopenia and Muscle (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- UKnowledge (University of Kentucky) (submittedVersion, cc-by-nc-nd)
- Funders
- American College of Gastroenterology Institute 2011
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- myosteatosis, sarcopenia, liver cirrhosis, mortality, skeletal muscle, hepatic steatosis, prognostic factors, hepatitis C, alcoholic cirrhosis, nonalcoholic steatohepatitis, autoimmune liver disease, hepatitis B, body mass index
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