Reply.

Abstract

Thank you for your interest in our recent publication 'Handgrip strength adds more prognostic value to the Model for End-Stage Liver Disease score than imaging-based measures of muscle mass in men with cirrhosis' (1). We agree that the most widely recognised definition of sarcopenia, proposed by the European Working Group on Sarcopenia in Older People (EWGSOP) incorporates both low muscle strength and low muscle mass (2). Hence the letter authors are critical of our use of a sarcopenia 'diagnosis' based on individual tests results only (handgrip strength (HGS), dual energy X-ray absorptiometry (DEXA) lean mass, and single slice computed tomography (CT) scan at the fourth lumbar vertebra). Whilst acknowledging that our sarcopenia diagnosis does not meet the criteria proposed by EWGSOP, it is important to note the majority of literature relating to cirrhotic patients, report only CT-based measures of muscle mass (3-5).