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Background & Aims: The subjective global assessment (SGA) is commonly used to assess nutritional status in patients with cirrhosis. Sarcopenia, a major component of malnutrition, is associated with survival in cirrhosis, and can be objectively diagnosed by computing the skeletal muscle index (SMI) using cross-sectional imaging. The aim of this study was to assess the prevalence of sarcopenia between SGA categories in patients with cirrhosis, and to determine their association with decompensation/mortality., Methods: We included 315 patients (66% males) who were assessed for liver transplantation. All patients had SGA and SMI, and were evaluated for the presence of hepatic encephalopathy (HE) and ascites., Results: Mean age was 54 ± 8 years. SGA categories were 126 SGA A (40%), 155 SGA B (49%), 34 SGA C (11%). Sarcopenia was present in 121 (38%) patients; of these, 82% were SGA A/B. Of SGA A patients, 25 (20%) had sarcopenia. There was a significant but only weak concordance between sarcopenia and SGA B/C (κ = 0.28, p < 0.001), and SGA C (κ = 0.13, p < 0.001). The latter was lost in overweight/obese patients. SGA B/C was associated with HE (OR 2.8, p = 0.01) and ascites (OR 2.3, p = 0.002). Median survival was shorter in patients with sarcopenia (20 [IQR 15.9-24.5] vs. 42 [IQR: 25.8-58.9] months, p < 0.001) and in SGA C patients (9.4 [IQR: 0-26.2] vs. 33 [IQR 20.2-45.7] months, p = 0.01). In univariate analysis both sarcopenia and SGA C were associated with mortality, but sarcopenia was the only factor that remained significant on multivariate analysis., Conclusions: There was only a weak concordance between SGA and sarcopenia. This concordance was non-significant in patients who were overweight/obese. Sarcopenia was associated with mortality, whereas SGA was not. Sarcopenia by the SMI is a more efficient method to predict adverse outcomes in a timely fashion and has prognostic implications., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Two major body compartments, skeletal muscle and adipose tissue, exhibit independent functions. We aimed to explore the prognostic significance of skeletal muscle, visceral and subcutaneous adipose tissue, according to sex, in patients with cirrhosis assessed for liver transplantation (LT)., Methods: CT images taken at the 3rd lumbar vertebra from 677 patients were quantified for three body composition indexes (cm 2 /m 2 ), visceral adipose tissue index, subcutaneous adipose tissue index (SATI), and skeletal muscle index (SMI). Cox proportional and competing-risk analysis hazard models were conducted to assess associations between mortality and body composition., Results: The majority of patients were male (67%) with a mean age of 57 ± 7 years, model for end-stage liver disease (MELD) score of 14 ± 8 and mean body mass index of 27 ± 6 kg/m 2 . Despite similar body mass index between the sexes, male patients had greater SMI (53 ± 12 vs. 45 ± 9 cm 2 /m 2 ), whereas SATI (67 ± 52 vs. 48 ± 37 cm 2 /m 2 ) was higher in females (p <0.001 for each). In sex stratified multivariate analyses after adjustment for MELD score and other confounding variables, SATI in females (hazard ratio [HR] 0.99; 95% CI 0.98-1.00; p = 0.01) and SMI in males (HR 0.98; 95% CI 0.96-1.00; p = 0.02) were significant predictors of mortality. Female patients with low SATI (<60 cm 2 /m 2 ) had a higher risk of mortality (HR 2.06; 95% CI 1.08-3.91; p = 0.03). Using competitive risk analysis in female patients listed for LT, low SATI was also an independent predictor of mortality (subdistribution HR 2.80; 95% CI 1.28-6.12; p = 0.01) after adjusting for MELD, and other confounding factors., Conclusions: A lower SATI is associated with higher mortality in female patients with cirrhosis. Subcutaneous adipose tissue has a favorable metabolic profile - low SATI may reflect depletion of this major energy reservoir, leading to poor clinical outcomes., Lay Summary: We looked at the importance of two of the main body compartments, skeletal muscle and adipose tissue (fat) on the prognosis of males and females with end-stage liver disease. Lower amounts of subcutaneous fat but not visceral fat (around internal organs), are associated with higher mortality in female patients with end-stage liver disease. However, low skeletal muscle predicts mortality in male patients with end-stage liver disease., (Copyright © 2018. Published by Elsevier B.V.)