Body composition and bone mineral density in patients with advanced liver cirrhosis

Malnutrition is common in patients with advanced stages of liver cirrhosis, eventually leading to alterations of body composition (BC) and further complications. In this study, we analyzed prevalence and prognostic impact of impaired bone mineral density (BMD) and loss of muscle mass in patients with liver cirrhosis and portal hypertension.

BMD of 116 patients with liver cirrhosis allocated to transjugular intrahepatic portosystemic shunt (TIPS-) implantation was analyzed by dual-energy X-ray absorptiometry (DXA). Additionally, BC was assessed by DXA in 107 patients. Impaired BMD was defined by a T-score≤-1, osteoporosis by a T-score≤-2.5. An appendicular skeletal muscle index<7.26 (men) and<5.45 (women) defined sarcopenia.

Most patients had advanced liver cirrhosis with a Child-Pugh-Stadium B (63.9%) or C (19.7%). 48.6% were sarcopenic with a predominance of male patients (58.7% vs. 25.0%, p=0.001). Moreover, 69.8% had impaired BMD and 34.5% osteoporosis. Alcohol consumption and presence of ascites were not associated with sarcopenia or impaired BMD. Lower body mass index (BMI) was an independendent risk factor for both (sarcopenia: OR 0.751, p<0.001; impaired BMD: OR 0.849, p<0.001). Additionally, male sex was an independent risk factors for sarcopenia (OR 11.484, p<0.001). Impaired BMD, but not sarcopenia, negatively influenced 12-month survival after TIPS-implantation (HR 2.573, p=0.033).

Sarcopenia and impaired BMD are very common in patients with advanced liver cirrhosis and represent risk factors for complications and death. Therefore, assessment of nutritional status and specific treatment should be included in clinical practice.

Publication History

Article published online:
23 January 2024