Clinical Significance and Therapeutic Approach Concerning Various Abdominal Adipose Tissue Irregularities in End‐Stage Liver Disease

Accumulating evidence suggests that body mass index is an inaccurate measure of body composition mainly due to its limitation in differentiating distinct compartments in cirrhosis. Adipose tissue, as one of the most important body components, is likely to be misestimated. Cross-sectional imaging using CT or MRI can demonstrate the objective distribution of adipose tissue in patients with end-stage liver disease. CT allows a more precise assessment of adipose tissue and has been increasingly used as a non-invasive metric with substantially predictive and prognostic value. Based on CT, visceral adipose tissue index, subcutaneous adipose tissue index, and the ratio of visceral to subcutaneous adipose tissue area are indicators to measure various adipose tissues. In recent years, the relationship between adipose tissue and prognostication in those populations has been widely investigated, but conclusions remain controversial. Therefore, in this review, we focus on the distribution and function of adipose tissue and seek to define parameters commonly used to measure adipose tissue. We also discuss the association between various indices above mentioned and the development, complications, and mortality of end-stage liver disease in terms of recent data and emerging evidence. Finally, we shed light on potential management against adipose tissue irregularities through nutritional, physical, and pharmacological methods. It is concluded that comprehensive evaluation of fat distribution may help to predict and improve the prognosis of patients with end-stage liver disease.