The accuracy of screening instruments for sarcopenia: a diagnostic systematic review and meta-analysis

Risk Prediction Models for Sarcopenia in Patients Undergoing Maintenance Haemodialysis: A Systematic Review and Meta-Analysis

BACKGROUND

The number of risk prediction models for sarcopenia in patients undergoing maintenance haemodialysis (MHD) is increasing. However, the quality, applicability, and reporting adherence of these models in clinical practice and future research remain unknown.

OBJECTIVE

To systematically review published studies on risk prediction models for sarcopenia in patients undergoing MHD.

DESIGN

Systematic review and meta-analysis of observational studies.

METHODS

This systematic review adhered to the PRISMA guidelines. Search relevant domestic and international databases, which were searched from the inception of the databases until November 2023. The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist was used to extract data. The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist was used to assess the risk of bias and applicability. The Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) was used to assess the reporting adherence.

RESULTS

A total of 478 articles were retrieved, and 12 prediction models from 11 articles were included after the screening process. The incidence of sarcopenia in patients undergoing MHD was 16.38%-37.29%. The reported area under the curve (AUC) ranged from 0.73 to 0.955. All studies had a high risk of bias, mainly because of inappropriate data sources and poor reporting in the field of analysis. The combined AUC value of the six validation models was 0.91 (95% confidence interval: 0.87-0.94), indicating that the model had a high discrimination.

CONCLUSION

Although the included studies reported to some extent the discrimination of predictive models for sarcopenia in patients undergoing MHD, all studies were assessed to have a high risk of bias according to the PROBAST checklist, following the reporting guidelines outlined in the TRIPOD statement, and adherence was incomplete in all studies.

REGISTRATION NUMBER

CRD42023476067.

A study on the balance ability and plantar pressure of sarcopenia patients in different standing postures

BACKGROUND

Sarcopenia usually manifests as a decrease in muscle mass and strength, seriously affecting the quality of life and independent living ability of elderly people. Moreover, sarcopenia is associated with various adverse outcomes such as mortality, postoperative infections, and severe complications, as well as affecting the balance and plantar pressure of the elderly.

RESEARCH QUESTION

What are the characteristics of balance ability and plantar pressure in sarcopenia population across different standing postures?

METHODS

A plantar pressure measurement system was used to measure the COP parameters and plantar pressure of 70 individuals in four standing postures: Feet 10 cm apart (FA), Feet together (FT), Feet Semi Tandem (FST), and Feet Full Tandem (FFT). The plantar area was divided into ten regions based on the anatomical structure of the foot. An independent samples t-test was conducted for significance testing, and developed sarcopenia screening models based on binary logistic regression.

RESULTS

Research has found that there are significant differences in the center of plantar pressure (COP) speed, 95 % elliptical region, COP length, and short axis length between populations with and without sarcopenia in the FST stance. The analysis of plantar pressure showed that the main differences between the two groups were located in the metatarsal and heel regions, and the accuracy of the binary logistic regression model constructed based on the FFT stance plantar pressure data without weight-adjusted for screening sarcopenia was as high as 94.3 %, which was superior to other standing postures.

SIGNIFICANCE

The difference in balance ability between sarcopenia population and non-sarcopenia population is reflected in standing posture with a relatively narrower base of support on the plantar surface (FST), and FFT stance plantar pressure can be used as a new method for screening sarcopenia.

The diagnostic performance of phase angle for sarcopenia among older adults: A systematic review and diagnostic meta-analysis

OBJECTIVE

Phase angle is a promising tool for diagnosing sarcopenia. This study aimed to summarize its diagnostic performance by performing a systematic review and meta-analysis.

METHODS

We conducted a systematic search of PubMed, Web of Science, Embase, and Scopus. The Quality Assessment of Diagnostic Accuracy Studies, Version 2, was used to evaluate the quality of the studies. A bivariate random effects model was employed for data synthesis, and diagnostic performance was reported in terms of pooled sensitivity, specificity, and the area under the summary receiver operating characteristic curve (AUC). Additionally, meta-regression, subgroup analyses, and sensitivity analyses were performed.

RESULTS

A total of 15 studies were included in this meta-analysis, involving 4,063 participants. The overall risk of bias in the included studies was high. The meta-analysis revealed that the pooled sensitivity and specificity across all studies were 0.74 [95 % confidence interval (CI): 0.71-0.78] and 0.75 (95 % CI: 0.70-0.79), respectively, with an AUC of 0.79 (95 % CI: 0.76-0.83). Meta-regression indicated that study design, country, population, sex-specificity, and age may influence the diagnostic performance of phase angle. The optimal diagnostic performance was observed in the cut-off interval of 4.20 to 4.50°.

CONCLUSION

The phase angle demonstrated moderate diagnostic performance for sarcopenia, and the possible cut-off interval is 4.20 to 4.50 °. However, large-scale, multicenter prospective studies are necessary to assess its clinical applicability at specific cut-off values.

Nomogram to screen older adult patients attending the radiology department for sarcopenia

BACKGROUND

Sarcopenia is an age-related syndrome that can impact the physical and mental health of older adults. However, it is often overlooked in clinical practice. Therefore, we aim to construct a nomogram based on simplified discriminant parameters for screening older adult patients for sarcopenia risk.

METHODS

This cross-sectional study included 654 patients aged ≥ 60 years who underwent an examination in the radiology department between October 2023 and June 2024. Patients were diagnosed with sarcopenia according to the method and cutoff value criteria proposed the Asian Working Group on Sarcopenia (AWGS) 2019 criteria. Calf circumference (CC), SARC-F score, mid-upper arm circumference (MUAC), and SARC-CalF score were used as simplified discriminant parameters for sarcopenia. The discriminative ability of these parameters for sarcopenia was assessed using receiver operating characteristic analysis. Additionally, we included each screening parameter and evaluated it's important for screening for the presence of sarcopenia via univariate and multivariate logistic regression analysis to develop a new screening nomogram model. The performance of the nomogram was evaluated using receiver operating characteristic curves, and the performance of the nomogram model was compared to that of CC, SARC-F, MUAC, and the SARC-CalF using the Delong test.

RESULTS

Of the 654 subjects, 120 (18.3%) were diagnosed with sarcopenia, and the areas under the curve (AUCs) of the CC, SARC-F, MUAC, and SARC-CalF were 0.73, 0.61, 0.66, and 0.70, respectively. The multivariate analysis results revealed that older age, male sex, low CC, low MUAC, and low strength were related to sarcopenia. A nomogram model constructed with these five variables had an AUC of 0.84. The DeLong test showed that the diagnostic efficacy of the joint model was significantly higher than that of CC, SARC-F, MUAC, and SARC-CalF.

CONCLUSIONS

Our simple nomogram based on simplified discriminant parameters offers personalized sarcopenia screening for older adult patients attending the radiology department.

Social media-based Health Education plus Exercise Program (SHEEP) to improve muscle function among young-old adults with possible sarcopenia in the community: A feasibility study protocol

BACKGROUND

Despite the comparatively high prevalence of possible sarcopenia among young-old adults in the community, there is currently no available and effective social media-based intervention to increase the awareness and change the behavior of the target population to prevent sarcopenia. Using co-design methodology, we developed a multicomponent intervention strategy of health education and exercise for sarcopenia prevention utilizing the TikTok platform.

OBJECTIVES

The primary purpose of this study is to examine the feasibility and acceptability of the social media-based intervention to enhance muscle function in community-dwelling young-old adults with possible sarcopenia.

METHODS

This protocol outlines the entire research procedure for a prospective single-arm pre-post feasibility study employing a mixed-method design, which will be conducted between May 2024 and September 2024. Thirty-five older adults aged 60-69 years with possible sarcopenia will be recruited from two communities in Changsha, China. Using the TikTok platform, participants will be required to view a total of seven health education videos in the first week, and each video lasts four to six minutes. Then, participants will receive six-week multi-component exercise through TikTok, with at least three sessions/week, 30 minutes/session, and moderate intensity. Data collection will be conducted in baseline, week 1, 4, 7, 10 and 13. The primary outcomes will include evaluating recruitment capability, data collection procedure, outcome measurement, intervention procedures' acceptability, researchers' ability to manage and implement the study, among others. The secondary outcome is to compare standard measures for muscle function (e.g. handgrip strength, skeletal muscle mass, physical performance), body composition (e.g. body fat, body mass index, bone mineral), and other measures (e.g. perceived knowledge, personal motivation, behavioral skills). Finally, all participants will be offered a semi-structured interview to assess their in-depth experiences with the intervention and research process.

DISCUSSION

This study will be the first social-media based multicomponent intervention program for community young-old adults with possible sarcopenia to improve their muscle function, awareness and behavior of preventing sarcopenia. Findings will generate new evidence regarding the use of social media in health education for improving awareness of sarcopenia prevention, as well as the feasibility of using social media to influence participants' behavioral changes through exercise. This may help researchers identify ways to optimize acceptability and efficacy of the SHEEP intervention for the targeted population.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN17269170, Registered 14 September 2023.

Performance of the SARC-F, SARC-CalF, and calf circumference for sarcopenia case finding in community-dwelling older adults

PURPOSE

We compared the performance of SARC-F, SARC-CalF, calf circumference (CC), and body mass index (BMI)-adjusted CC for sarcopenia case-finding in community-dwelling older adults.

METHODS

Data of Finnish participants (women/men n = 192/36, mean age (SD) of 76.9 (4.8) years) recruited in the SPRINTT trial (NCT02582138) were used. Sarcopenia was determined as a combination of low muscle function (chair-stand-test) and low appendicular lean mass (ALM) detected by whole-body dual-energy X-ray absorptiometry. Associations of case-finding tools with sarcopenia were analysed using ROC curves and logistic regression.

RESULTS

The rates of probable and confirmed sarcopenia were 95% and 18% in women and 94% and 36% in men, respectively. Performance of CC for sarcopenia (women AUC 0.85 [95% CI 0.78-0.92]/ men 0.85 [95% CI 0.71-1.0]) was superior to that of other tools; (AUC in women/men for SARC-F was 0.57/0.50, for SARC-CalF 0.76/0.79, and for BMI-adjusted CC 0.68/0.66). The best performance was found for a CC cut-off point of ≤ 34 cm in women with sensitivity/specificity 82.4/75.3% and ≤ 36 cm in men with sensitivity/specificity 76.9/87.0%. For each cm decrease in CC, adjusted for age and BMI, there was a 30% increase in the odds of sarcopenia in women (OR 1.30, 95% CI 1.09─1.56). Although there was a similar pattern in men, the results did not reach statistical significance (OR 1.34, 95% CI 0.84- 2.14).

CONCLUSIONS

CC was superior to other tools for sarcopenia case-finding. The best performance was found for a CC cut-off point of ≤ 34 cm in women and ≤ 36 cm in men.

Development and validation of a screening tool for sarcopenia in Chinese nursing home residents

Sarcopenia, characterized by the loss of muscle mass and function, is a critical health issue in nursing home residents. Given the high prevalence of sarcopenia in care settings, effective screening is crucial. This study compared the diagnostic accuracy of two conventional sarcopenia screening tools, SARC-F and SARC-CalF, and developed an alternative tool, SEAC, specifically for nursing home residents. In a sample of 679 older adults from Zhejiang Province, SARC-CalF exhibited better sensitivity and diagnostic accuracy compared to SARC-F. The SEAC tool, incorporating strength, exhaustion, assistance in walking, and calf circumference, demonstrated the highest diagnostic accuracy and sensitivity among the three screening tools. These findings suggest that SEAC could serve as a valuable tool for large-scale sarcopenia screening in nursing homes, potentially improving early detection and management of sarcopenia in this vulnerable population.

The Diagnostic Accuracy and Cutoff Value of Phase Angle for Screening Sarcopenia: A Systematic Review and Meta-Analysis

OBJECTIVES

Phase angle (PhA) declines with age and is a reliable marker for muscle function, making it a potential screening indicator for sarcopenia. However, studies examined the reliability and validity of PhA for detecting sarcopenia, yielding inconsistent results. This meta-analysis aimed to evaluate the accuracy and cutoff value of PhA for screening sarcopenia and examine the potential confounding factors.

DESIGN

This is a meta-analysis.

SETTING AND PARTICIPANTS

PubMed, Embase, and Cochrane Library were searched up to September 18, 2023. Eighteen studies (6184 participants) were included reporting the diagnostic accuracy of PhA for screening sarcopenia.

METHODS

Pooled accuracy [ie, the computed area under the curve value (AUC)] and cutoff value interval for screening sarcopenia were estimated using a random-effects model. Meta-regression analyses were conducted to identify sources of heterogeneity.

RESULTS

The AUC value was 0.81. Pooled sensitivity and specificity were 80% and 70%. The calculated 95% CI of the cutoff value of PhA for screening sarcopenia falls between 4.54° and 5.25°. The results of meta-regression analyses showed that ethnicity, body mass index (BMI), health status, and diagnostic criteria were the main factors affecting the diagnostic accuracy for screening sarcopenia (with all P values < 0.01).

CONCLUSION AND IMPLICATIONS

PhA may serve as a robust screening tool for sarcopenia, and the recommended cutoff interval falls between 4.54° and 5.25°. Ethnicity, BMI, health status, and diagnostic criteria can affect PhA's efficacy in sarcopenia screening.

Associations of sarcopenia, obesity, and metabolic health with the risk of urinary incontinence in U.S. adult women: a population-based cross-sectional study

Introduction

Urinary incontinence (UI) significantly impairs women's quality of life. Identifying its risk factors is essential for developing effective interventions. Sarcopenia, characterized by the accelerated loss of muscle mass and function, is an emerging concern often linked to obesity and abnormal metabolic status, exacerbating various adverse health outcomes. This population-based study aimed to explore the independent and joint associations of sarcopenia, obesity, and metabolic health with UI risk, as well as to evaluate the mediating role of metabolic indicators in these associations.

Methods

A total of 3,557 women aged ≥20 years from the National Health and Nutrition Examination Survey were included. Sarcopenia was assessed using the appendicular lean mass index (ALMI), and obesity was defined by body mass index and waist circumference. Metabolic health was evaluated using revised criteria from the National Cholesterol Education Program-Adult Treatment Panel III. UI was identified through responses to the "Kidney Conditions-Urology" questionnaire and classified into stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). Multivariable logistic regression and restricted cubic spline models were used to evaluate the associations and visualize the relationship between ALMI and UI. Mediation models were constructed to assess the mediating role of metabolic indicators.

Results

We found that sarcopenia was significantly associated with an increased risk of MUI in the general population. Age-specific analysis revealed that sarcopenia is an independent risk factor for SUI in women aged ≥60, and for MUI in women aged 40-59 years. Sarcopenic obesity, particularly under central obesity criteria, further elevated the risk of UI. Notably, women with the metabolically unhealthy obese phenotype with sarcopenia were at the highest risk for both SUI and MUI. Metabolically unhealthy status, glycohemoglobin, vitamin D, and serum albumin levels were partial mediators of these associations.

Conclusion

Our findings elucidated the complex interactions between sarcopenia, obesity, and metabolic health, underscoring the critical need for integrated therapeutic strategies that address both metabolic health and targeted nutritional interventions, aiming to enhance muscular health and effectively manage and prevent UI.

Sarcopenia

Sarcopenia is the accelerated loss of skeletal muscle mass and function commonly, but not exclusively, associated with advancing age. It is observed across many species including humans in whom it can lead to decline in physical function and mobility as well as to increased risk of adverse outcomes including falls, fractures and premature mortality. Although prevalence estimates vary because sarcopenia has been defined in different ways, even using a conservative approach, the prevalence is between 5% and 10% in the general population. A life course framework has been proposed for understanding not only the occurrence of sarcopenia in later life but also influences operating at earlier life stages with potentially important implications for preventive strategies. Harnessing progress in understanding the hallmarks of ageing has been key to understanding sarcopenia pathophysiology. Considerable convergence in approaches to diagnosis of sarcopenia has occurred over the last 10 years, with a growing emphasis on the central importance of muscle strength. Resistance exercise is currently the mainstay of treatment; however, it is not suitable for all. Hence, adjunctive and alternative treatments to improve quality of life are needed. An internationally agreed approach to definition and diagnosis will enable a step change in the field and is likely to be available in the near future through the Global Leadership Initiative in Sarcopenia.

The Prevalence and Prognosis of Cachexia in Patients with Non-Sarcopenic Dysphagia: A Retrospective Cohort Study

The purpose of this study was to assess the prevalence and prognosis of cachexia in patients with non-sarcopenic dysphagia. A retrospective cohort study was conducted using the Japanese sarcopenic dysphagia database. Cachexia was diagnosed using the Asian Working Group for Cachexia criteria, sarcopenia using the Asian Working Group for Sarcopenia 2019 criteria, and malnutrition using the Global Leadership Initiative on Malnutrition criteria. Outcomes were death, swallowing function (Food Intake LEVEL Scale (FILS)), and activities of daily living (Barthel Index (BI)). The mean age of the 175 non-sarcopenic dysphagia patients was 77 (±11) years; 103 (59%) were male, 30 (17%) had cachexia, 133 (76%) had whole-body sarcopenia, and 92 (53%) were malnourished. Of the 30 patients with cachexia, 4 and 11 did not have sarcopenia and malnutrition, respectively. No significant associations were found between cachexia, sarcopenia, and malnutrition. Death was notably higher in the cachexia group (5/30; 17% vs. 2/145; 1%, p = 0.002). Median FILS (7 vs. 8, p = 0.585) and median BI (35 vs. 50, p = 0.469) scores did not show significant differences based on cachexia status. The prevalence of cachexia was 17%, and mortality may be higher with cachexia in non-sarcopenic dysphagia patients.

Use of the Ishii Test for screening sarcopenia in older adults: a systematic review with meta-analysis of diagnostic test accuracy (DTA) studies

BACKGROUND

The Ishii Test is recommended by the European Working Group on Sarcopenia in Older People (EWGSOP2), however the use of this technique is still little explored in the clinical context and the scientific literature.

OBJECTIVE

We aimed to verify the use of the Test of Ishii in screening for sarcopenia in older adults.

METHODS

We searched three electronic databases and two reviewers independently screened and assessed the studies. Studies with older adults (60 years or more) of both genders, no year or language restriction and which aimed to evaluate sarcopenia using the Ishii Test and another diagnostic criteria were selected. A summary of the ROC curve, sensitivity and specificity were performed using the MedCalc and SPSS software programs, respectively.

RESULTS

A total of 3,298 references were identified in the database, 278 by manually searching, and finally 11 studies were included for the review. The screening test showed good sensitivity and specificity in both genders. All studies showed values above the considered value for the Area Under the Curve (AUC) results, without discriminating power (0.500). Four studies used the original values, and five studies developed a new cut-off point. A summary of the AUC curve showed the diamond close to one, indicating that the Ishii test has good performance for screening sarcopenia (I2=83,66%; p<0.001; 95%CI: 69.38 to 91.28 for men; and I2=60.04%; p<0.001; 95%CI: 13.06 to 81.63 for women).

CONCLUSION

The Ishii Test can be considered a useful tool for the early identification of sarcopenia in older adults. However, further studies are still needed to understand the behavior of this screening tool.

TRIAL REGISTRATION

CRD42023424392.

Investigating the effects of synbiotic supplementation on functional movement, strength and muscle health in older Australians: a study protocol for a double-blind, randomized, placebo-controlled trial

BACKGROUND

Aging has been associated with a progressive loss of skeletal muscle quality, quantity and strength, which may result in a condition known as sarcopenia, leading to a decline in physical performance, loss of independence and reduced quality of life. While the cause of impaired physical functioning observed in elderly populations appears to be multifactorial, recent evidence suggests that age-associated alterations in gut microbiota could be a contributing factor. The primary objective will be to assess the effects of a dietary synbiotic formulation on sarcopenia-related functional outcomes such as handgrip strength, gait speed and physical performance within older individuals living independently. The secondary objective will be to examine associations between changes in gut microbiota composition, functional performance and lean muscle mass.

METHODS

Seventy-four elderly (60-85 years) participants will be randomized in a double-blind, placebo-controlled fashion to either an intervention or control group. The intervention group (n = 37) will receive oral synbiotic formulation daily for 16 weeks. The control group (n = 37) will receive placebo. Assessments of physical performance (including Short Physical Performance Battery, handgrip strength and timed up-and-go tests) and muscle ultrasonography will be performed at 4 time points (baseline and weeks 8, 16 and 20). Likewise, body composition via bioelectric impedance analysis and blood and stool samples will be collected at each time point. Dual-energy X-ray absorptiometry will be performed at baseline and week 16. The primary outcomes will be between-group changes in physical performance from baseline to 16 weeks. Secondary outcomes include changes in body composition, muscle mass and architecture, fecal microbiota composition and diversity, and fecal and plasma metabolomics.

DISCUSSION

Gut-modulating supplements appear to be effective in modifying gut microbiota composition in healthy older adults. However, it is unclear whether these changes translate into functional and/or health improvements. In the present study, we will investigate the effects of a synbiotic formulation on measures of physical performance, strength and muscle health in healthy older populations.

TRIAL REGISTRATION

This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000652774) in May 2022.

The diagnostic performance of Cr/CysC for sarcopenia and its predictive value on clinical outcomes in hospitalized older patients: a prospective cohort study

PURPOSE

The utilization of the creatinine-to-cystatin C ratio (Cr/CysC) represents an innovative method for predicting sarcopenia. Our objectives encompassed the evaluation of sarcopenia diagnostic accuracy for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score, as well as an exploration of the predictive value of Cr/CysC concerning clinical outcomes within hospitalized older individuals.

METHODS

We employed receiver operating characteristic (ROC) curves and calculated areas under the curves (AUCs) to assess the diagnostic accuracy. Furthermore, we applied univariate and multivariate Cox proportional-hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) of risk factors affecting prognosis.

RESULTS

Our study included 312 participants, comprising 167 men and 145 women, with an average age of 71 years. Among males, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.717 [95% CI 0.642-0.784], 0.669 (95% CI 0.592-0.739), 0.845 (95% CI 0.781-0.896), 0.882 (95% CI 0.823-0.926), and 0.938 (95% CI 0.890-0.969), respectively. In females, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.706 (95% CI 0.625-0.779), 0.631 (95% CI 0.547-0.710), 0.763 (95% CI 0.686-0.830), 0.789 (95% CI 0.714-0.853), and 0.898 (95% CI 0.837-0.942), respectively. After adjusting for age, sex, physical exercise, smoking, drinking, hypertension, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and cancer, sarcopenia identified by Cr/CysC (adjusted HR = 2.176, 95% CI 1.062-4.460, P = 0.034) was independently associated with poor overall survival in hospitalized older patients.

CONCLUSIONS

Cr/CysC has satisfactory diagnostic accuracy for sarcopenia diagnosis and predictive value for poor outcomes in hospitalized older patients. The combination of Cr/CysC and SARC-CalF may provide a more accurate screening for sarcopenia and the Ishii score may be the most accurate clinical method for detecting sarcopenia.

A Low Geriatric Nutritional Risk Index Is Associated with Low Muscle Volume and a Poor Prognosis among Cirrhotic Patients

Background and Objectives: The geriatric nutritional risk index (GNRI) is an easily calculable index that can be determined using three common clinical variables. The GNRI is suggested to be related to sarcopenia in cirrhotic patients. However, the relationship between the GNRI and the prognosis in patients with liver cirrhosis (LC) has not been reported. The aim of the present research is to study the association of the GNRI with the nutritional status, hepatic function reserve, and prognosis in patients with liver cirrhosis (LC). Materials and Methods: A total of 370 cirrhotic patients whose nutritional statuses were evaluated using anthropometric measurements and bioimpedance analysis were studied. The associations between the GNRI and nutritional status and the GNRI and hepatic function reserve were analyzed. We also investigated the GNRI and prognosis of patients with LC. Results: The median age of the enrolled patients was 66 years old, and 266 (71.9%) patients had viral hepatitis-related LC. The GNRI was shown to decrease with the progression of chronic liver disease, represented by an increased FIB-4 index and severe Child-Pugh and mALBI grades. In addition, a low GNRI (<92) was associated with severe cirrhosis-related metabolic disorders, including a low branched-chain amino acid-to-tyrosine ratio (BTR) and a low zinc value. The GNRI was positively correlated with two nutrition-related anthropometric variables (% arm circumference and % arm muscle circumference), and a low GNRI was related to a low skeletal muscle mass index (SMI) (<7.0 kg/m2 for men or <5.7 kg/m2 for women), as determined by using bioimpedance analysis. In addition, patients with a low GNRI (<92) had a poorer prognosis than those with a high GNRI (≥92) (log-rank test: p = 0.0161, and generalized Wilcoxon test, p = 0.01261). Conclusions: Our results suggest that a low GNRI is related to severe chronic liver disease, low muscle volume, and a poor prognosis of patients with cirrhosis.