Phd in EXPERIMENTAL AND CLINICAL HEPATO-GASTROENTEROLOGY

Thesis title: Body Composition in Liver Cirrhosis and After Transjugular Intrahepatic Portosystemic Shunt: Prognostic Impact and Clinical Assessment

Malnutrition represents a major determinant of morbidity and mortality in patients with liver cirrhosis, being closely associated with sarcopenia, myosteatosis, and frailty. Nutritional impairment not only reflects disease severity but also contributes to its progression, influencing clinical outcomes, quality of life, and survival. The doctoral project aimed to explore the impact of body composition changes in cirrhosis, both in the natural history of the disease and after transjugular intrahepatic portosystemic shunt (TIPS), through three complementary studies performed during the PhD program. Methods The thesis includes three main works: Study 1 – A prospective multicenter study evaluating the prevalence and prognostic relevance of sarcopenia and myosteatosis in a large cohort of patients with cirrhosis. Study 2 – A systematic review summarizing the available evidence on the bidirectional relationship between TIPS and nutritional status, analyzing how TIPS may both be influenced by and modify body composition. Study 3 – A prospective multicenter study specifically designed to assess longitudinal changes in body composition after TIPS placement and their association with clinical outcomes. Results In Study 1, myosteatosis and sarcopenia were highly prevalent (≈70% and 40% respectively) and myosteatosis was strongly associated with mortality, hospitalizations, and liver decompensation. The systematic review (Study 2) highlighted heterogeneous but consistent evidence indicating that poor nutritional status predicts post-TIPS complications, while TIPS may, in turn, improve muscle mass and nutritional parameters through reduced portal hypertension and inflammation. In Study 3, TIPS led to a significant improvement in muscle mass, as well as a improvement in visceral and subcutaneous adipose tissue distribution. A trend toward worse outcomes was observed in patients who were malnourished at baseline or failed to improve after TIPS, although not reaching statistical significance. Conclusions Malnutrition and body composition alterations are key prognostic factors in cirrhosis and after TIPS. An integrated evaluation of muscle and adipose compartments is essential for accurate risk stratification and for guiding nutritional and clinical management. The findings from these studies contribute to refining the prognostic role of nutrition in advanced liver disease and support its inclusion in future therapeutic algorithms.