Sarcopenia in cirrhotic patients waiting for liver transplantation: is diabetes an additional aggravating factor?

Diabetes is a well demonstrated risk factor for poor prognosis in people with chronic liver disease. Conversely, the presence of hepatopathy may affect glucose homeostasis. In people with cirrhosis, sarcopenia is related to increased pre- and post-liver transplantation (LT) mortality. Diabetes mellitus and sarcopenia are both known complications of end-stage liver disease but, to date, no studies aimed at assess the clinical impact of their co-presence in LT-candidates are available. We performed a cross-sectional, single-center, observational study to assess the presence of sarcopenia in 112 people with cirrhosis and waiting for LT to investigate any correlation between this condition and the presence of glucose abnormalities. In our population, 10 (8.9%) subjects was diagnosed as sarcopenic. Diabetes appears to be strongly associated with sarcopenia in individuals with cirrhosis, affecting 100% of people from the sarcopenic (S) group (vs 59.8% in the non-sarcopenic -NS group). Subjects from the S group were older and showed lower BMI and fat mass vs subjects from NS group. Concerning to dietary behaviors, individuals from the S group showed adequate protein intake and achieved the recommended daily intake of fibers, as recommended in the context of nutritional trainings, routinely proposed to this population. In conclusion, the recognition and metabolic characterization of such frail individuals would allow to target them with structured nutritional and lifestyle educational programs, with the aim to achieve a better metabolic status in view of LT.