Relative Trunk Adipopenia Is Associated with the Severity of Liver Disease and Outcome in Patients with Cirrhosis

Background/Objectives: Regional adipose tissue has been studied as a prognostic factor in various extra-hepatic diseases, but data in the setting of cirrhosis is scarce. Our aim was to evaluate the association of regional adipose tissue indices with the severity of liver disease and its impact on the outcome of patients with cirrhosis. Methods: Three hundred and thirty-seven patients with cirrhosis were prospectively enrolled in the study. Clinical and laboratory data were recorded, and MELD-Na and Child-Turcotte-Pugh scores were calculated. Physical performance was evaluated with handgrip strength, the Short Physical Performance Battery test, and the Liver Frailty Index. Dual-energy X-ray absorptiometry was used for the evaluation of total and regional lean and fat mass. Results: A low trunk fat percentage was found to be independently associated with a MELD-Na score ≥ 15 (Odds Ratio: 0.92, p = 0.007). MELD-Na score and trunk fat percentage were the only factors independently associated with mortality [Hazard Ratio (HR): 1.078, p = 0.02 and HR: 0.95, p = 0.03, respectively], while a separate analysis based on gender confirmed this finding only in men. In the total cohort, patients with a trunk fat percentage < 27.5% had worse outcomes (log-rank 11.4; p < 0.001). Conclusions: This study marks the first effort to examine the association of indices related to regional adipose tissue distribution with the severity of liver disease and outcome. Trunk fat percentage was the only body composition parameter independently associated with advanced liver disease and prognosis in the total cohort specifically in men, but not in women. Further studies are needed to validate the predictive role of adipose tissue in patients with cirrhosis.