Nutrition and exercise in the management of liver cirrhosis

Table 1 Methods to assess protein-energy malnutrition and sarcopenia in liver cirrhosis patients

Method	Ability	Advantage	Disadvantage
PEM
Indirect calorimetry	To calculate energy expenditure and npRQ	Non-invasive and accurate	Expensive
	npRQ being a marker for survival
Anthropometric measurements	To estimate nutritional status and liver function	Simple and inexpensive	Possible errors related to the measurements
	AMC and TSF serve as markers for survival
	%AMC and %AC serve as alternatives to npRQ
Bioimpedance analysis	To estimate body cell mass	Convenient and inexpensive	Limitations in patients with ascites
	PA serves as a measure to estimate nutritional status and as a marker for survival	Comparable with the DXA and MRI methods in the assessment of skeletal muscle volume
Sarcopenia
Imaging method	To assess skeletal muscle volume
CT and MRI		Accurate	Radiation-exposed (CT)
DXA		Comparable with the CT and MRI methods
		Less radiation exposure and lower cost than the CT method
Handgrip strength	To measure muscle strength	Simple and inexpensive	Possible errors related to measurements
	A marker for nutritional status
	A predictor of hepatic decompensation

PEM: Protein-energy malnutrition; LC: Liver cirrhosis; npRQ: Non-protein respiratory quotient; AMC: Arm muscle circumference; TSF: Triceps skinfold thickness; AC: Arm circumference; PA: Phase angle; DXA: Dual energy X-ray absorptiometry; MRI: Magnetic resonance imaging; CT: Computed tomography.