Both muscle quantity and quality are predictors of waiting list mortality in patients with end-stage liver disease

Daphne Bot*, Anneke Droop, Claudia J. Lucassen, Mariëlle E. van Veen, Jeroen L.A. van Vugt, Shirin Shahbazi Feshtali, Eva Leistra, Maarten E. Tushuizen, Bart van Hoek

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Background and aims: Malnutrition is highly prevalent in patients with end-stage liver disease (ESLD) and associated with impaired clinical outcome. Previous studies focused on one component of body composition and not in combination with nutritional intake, while both are components of the nutritional status. We aimed to evaluate the most important risk factors regarding body composition (muscle mass, muscle quality and fat mass) and nutritional intake (energy and protein intake) for waiting list mortality in patients with ESLD awaiting liver transplantation (LTx). Methods: Consecutive patients with ESLD listed for LTx between 2007 and 2014 were investigated. Muscle mass quantity (Skeletal Muscle Mass Index, SMI), and muscle quality (Muscle Attenuation, MA), and various body fat compartments were measured on computed tomography using SliceOmatic. Nutritional intake (e.g. energy and protein intake) was assessed. Multivariable stepwise forward Cox regression analysis was used for statistical analysis. Results: 261 Patients (mean age 54 years, 74.7% male) were included. Low SMI and MA were found to be statistically significant predictors of an increased risk for waiting list mortality in patients with ESLD, with a HR of 2.580 (95%CI 1.055–6.308) and HR of 9.124 (95%CI 2.871–28.970), respectively. No association between percentage adipose tissue, and protein and energy intake with waiting list mortality was found in this study. Conclusion: Both low muscle quantity and quality, and not nutritional intake, were independent risk factors for mortality in patients with ESLD.

Original languageEnglish
Pages (from-to)272-279
Number of pages8
JournalClinical Nutrition ESPEN
Early online date10 Feb 2021
Publication statusPublished - Apr 2021

Bibliographical note

Publisher Copyright:
© 2021 The Author(s)

Copyright 2021 Elsevier B.V., All rights reserved.


  • Body composition
  • Liver cirrhosis
  • Liver transplantation
  • Malnutrition
  • Muscle
  • Sarcopenia


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