Knowledge Portal
Nutrition, frailty and rehabilitation
Malnutrition, sarcopenia and physical frailty overlap but are not interchangeable. All are common in advanced liver disease, are easily hidden by ascites or obesity, and are associated with infection, hospitalisation, poorer transplant outcomes and death. Assessment should combine nutritional screening with objective measures of muscle function or frailty where possible. In ICU, early enteral nutrition and avoidance of unnecessary protein restriction matter; after stabilisation, adequate protein, resistance and aerobic activity, and multidisciplinary prehabilitation or rehabilitation should be treated as active components of care rather than optional extras.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
Malnutrition, Frailty, and Sarcopenia in Patients with Cirrhosis
AASLD · practice guidance · 2021
The core AASLD framework for assessment, nutrition prescription and activity-based intervention.
Open resource →EASL Clinical Practice Guidelines on nutrition in chronic liver disease
EASL · guideline · 2019
European recommendations on energy and protein targets, meal timing, micronutrients and exercise.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Multidisciplinary approach to malnutrition and physical frailty in patients with decompensated cirrhosis
Armstrong MJ, Hopkins LJ, Towey J, Williams F, et al. Frontline Gastroenterology. 2025;16:e66–e76.
A practical pathway covering screening, multidisciplinary assessment, nutrition, exercise and service design.
Open resource →Frailty and Sarcopenia in Cirrhosis: Current Knowledge and Future Directions
D’Arcangelo F, Zanetto A. Current Hepatology Reports. 2025;24:10.
An open-access overview of definitions, measurement, mechanisms and interventions across the cirrhosis pathway.
Open resource →Nutritional aspects of prehabilitation in adults with cirrhosis awaiting liver transplant
Cruz C, Prado CM, Gillis C, et al. Hepatology. 2025;82(6):1582–1602.
A detailed review of nutritional assessment and the design of multimodal prehabilitation before transplantation.
Open resource →Why do we care about frailty in liver disease?
AASLD Liver Fellow Network · clinical explainer · 2024
An accessible introduction to frailty measurement, prognosis and modifiable contributors.
Open resource →Liver Frailty Index
University of California, San Francisco · calculator
The original bedside calculator for grip strength, chair stands and balance testing in cirrhosis.
Open resource →