Fig. 1

Experimental flow-chart. LSM was adopted to discriminate ≤ F3 patients and ACLD individuals, whereas the evaluation of LRDEs’ occurrence (ongoing and in the previous 12 months) distinguished cACLD and dACLD patients. In particular, LRDEs were: (a) progressive jaundice in not-cholestatic disease, (b) ascites, (c) HE, (d) variceal bleeding, or (e) any acute bacterial infections. The evidence of esophageal varices defined CSPH. Anthropometric parameters included Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Body Mass Index (BMI), and Waist-hip ratio (Whr) determination. Biochemical variables included platelet count (PLT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), Fasting Plasma Glucose (FPG), total cholesterol, High-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides (TG), serum albumin (SA), International-Normalized Ratio (INR), and creatinine. For ACLD, the Child-Pugh-Turcotte score was determined. Nutritional counseling was offered to all the patients: for this purpose, dietary and physical exercise habits were assessed, as well as the presence of dysgeusia (see the main text) and appetite levels. Nutritional status, including the evaluation for sarcopenia and frailty, was opportunely defined by using bioelectrical impedance analysis (BIA) and Liver Frailty Index (LFI) calculation. During a 6-month follow-up period, further LRDEs were recorded for dACLD.  At the baseline, as well as during the follow-up, LRDEs considered were (a) progressive jaundice in not-cholestatic disease, (b) ascites, (c) HE, (d) variceal bleeding, or (e) any acute bacterial infections. Jan: January; Dec: December; MASLD: Metabolic dysfunction-associated Steatotic Liver Disease; LSM: Liver stiffness measurement; ACLD: advanced chronic liver disease; cACLD: compensated advanced chronic liver disease; dACLD: decompensated advanced chronic liver disease. LRDEs: liver-related decompensation events; CSPH: Clinically Significant Portal Hypertension