{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T03:43:43Z","timestamp":1794109423724,"version":"4.8.0"},"reference-count":40,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Sarcopenia and frailty are prevalent and independently prognostic in cirrhosis. Few studies have evaluated both together to ascertain their interaction and phenotypic differences. None have studied their relationship with resting energy expenditure (REE). We simultaneously examined sarcopenia, frailty and REE in a cohort of patients with cirrhosis and portal hypertension\u2014a novel approach. Methods: We retrospectively studied consecutive patients with cirrhosis and portal hypertension, prospectively recruited between 2015 and 2018 to undergo sarcopenia (transversal psoas muscle thickness [TPMT]\/height), frailty (Fried Frailty Index [FFI]), and REE assessments via indirect calorimetry. The primary outcome was transplant-free survival (TFS). Results: Ninety-seven patients were recruited with sarcopenia and frailty present in 26% and 40%, respectively. Patients with sarcopenia or frailty alone were phenotypically similar except those with sarcopenia had lower median body mass index (BMI) (23 vs. 28 kg\/m2, p = 0.032) and were more likely to be hypermetabolic (60% vs. 0%, p = 0.017). Median TFS was lower in patients with sarcopenia (3.6 months) or frailty (4.5 months), compared to those with neither (10.3 months), while patients with both sarcopenia and frailty exhibited the worst TFS (1.8 months, log-rank p = 0.001). Independent predictors of death or liver transplant were sarcopenia, hepatic encephalopathy, and a higher model for end-stage liver disease score. Conclusions: In patients with cirrhosis and portal hypertension, sarcopenia and physical frailty are related but have differences in BMI and REE. The deleterious impact of sarcopenia and frailty on TFS are additive. Sarcopenia remains an independent predictor of TFS after adjusting for frailty.<\/jats:p>","DOI":"10.3390\/nu17243844","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T14:49:01Z","timestamp":1765291741000},"page":"3844","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Interactions Between Sarcopenia, Physical Frailty and Resting Energy Expenditure in Cirrhosis and Portal Hypertension"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7195-3154","authenticated-orcid":false,"given":"Rachael","family":"Jacob","sequence":"first","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"},{"name":"Concord Repatriation General Hospital, Sydney 2139, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Craik","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3664-2246","authenticated-orcid":false,"given":"Aviv","family":"Pudipeddi","sequence":"additional","affiliation":[{"name":"Concord Repatriation General Hospital, Sydney 2139, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8845-0695","authenticated-orcid":false,"given":"Laura","family":"Park","sequence":"additional","affiliation":[{"name":"Alfred Health, Melbourne 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Aw","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Royal Brisbane and Women\u2019s Hospital, Brisbane 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-3903","authenticated-orcid":false,"given":"Natalie","family":"Ngu","sequence":"additional","affiliation":[{"name":"Monash Health, Monash University, Melbourne 3800, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prahalath","family":"Sundaram","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8084-9968","authenticated-orcid":false,"given":"Helen","family":"Vidot","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4788-3253","authenticated-orcid":false,"given":"Talal","family":"Valliani","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4201-0173","authenticated-orcid":false,"given":"Madeleine","family":"Gill","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"},{"name":"Flinders Medical Centre, Adelaide 5042, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3721-0741","authenticated-orcid":false,"given":"Dominic","family":"Staudenmann","sequence":"additional","affiliation":[{"name":"Intesto-Gastroenterologische Praxis & Crohn-Colitis Zentrum, 3012 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7965-5581","authenticated-orcid":false,"given":"David","family":"Bowen","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia"},{"name":"Liver Immunology Program, Centenary Institute, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6374-1525","authenticated-orcid":false,"given":"Simone","family":"Strasser","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1483-1636","authenticated-orcid":false,"given":"Geoffrey","family":"McCaughan","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia"},{"name":"Liver Injury and Cancer Program, Centenary Institute, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0453-3168","authenticated-orcid":false,"given":"Ken","family":"Liu","sequence":"additional","affiliation":[{"name":"AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney 2050, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia"},{"name":"Liver Injury and Cancer Program, Centenary Institute, Sydney 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7637","DOI":"10.3748\/wjg.v21.i25.7637","article-title":"Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score","volume":"21","author":"Kim","year":"2015","journal-title":"World J. 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