Table 4.

An Empiric Standard of Care for Cirrhotic Frailty/Sarcopenia

Component	References
Complete a three‐domain frailty/sarcopenia assessment.  1. Anatomic: SMI from computed tomography or magnetic resonance imaging  2. Performance over time: 6‐minute walk, baseline gait speed  3. LFI baseline for future clinic visits	4, 6, 9
Identify, treat, and monitor muscle‐specific metabolic issues.  1. Diabetes, thyroid, and male testosterone status  2. Micronutrient deficits, especially vitamin D  3. Suppression of ammonia excess	2, 13, 15, 17
Evaluate and target motivational and performance barriers.  1. Self‐assessed physical performance capacity  2. Comorbid depression and substance use  3. Use of sedatives and narcotics	8, 12
Prescribe and monitor a nutritional program.  1. Individual energy requirements in Kcal/day  2. Protein 1.3‐1.5 g/kg/day, including a late evening feeding  3. Accommodate diabetes, salt, and fluid constraints	11, 15, 16, 17
Develop and execute a personalized activity program with patient engagement.  1. Identify, mitigate, and develop alternative programs to overcome specific musculoskeletal and neurological activity barriers, e.g., stationary biking, water aerobics, and calibrated resistance training bands  2. Ensure sustainability: home‐based activity, affordable, adequate time, availability of a family member, peer, or health coach  3. Balance aerobic with light resistance exercise, e.g., 80/20  4. Encourage wearable activity devices for self‐monitoring and goal setting, e.g., ≥5000 steps/day with ≥5% moderate/vigorous activity intensity	8, 9, 10, 11, 12, 13, 14, 15, 16, 17