Sarcopenia Diagnosis in Liver Disease

Sarcopenia was diagnosed according to the criteria advocated by the Japan Society of Hepatology (1st edition)^{6 (link)}. The average handgrip strength (HGS) of the left and right hands was measured twice in a standing position using a digital Smedley-type hand dynamometer (T.K.K5401 GRIP-D; Takei Scientific Instruments, Niigata, Japan). In addition, the skeletal muscle mass index (SMI) was assessed using bioelectrical impedance analysis (BIA; InBody S10; InBody Japan, Tokyo, Japan). The cutoff values for decreased handgrip strength and SMI were < 26 kg and < 7.0 kg/m² for men and < 18 kg and < 5.7 kg/m² for women, respectively. Patients undergoing hemodialysis, with massive ascites, or implants were excluded due to the unreliability of the BIA method^{7 (link)}. The 6-m walk was used to assess physical performance, with a slow gait speed defined as < 1.0 m/s.