The role of calf circumference in the measurement of sarcopenia in cirrhosis: a narrative review.

INTRODUCTION: Cirrhosis is a global health challenge associated with significant morbidity and mortality. Sarcopenia is a clinically relevant prognostic marker in cirrhosis but is frequently overlooked in traditional prognostic scores. Gold standard diagnosis relies on imaging modalities that are expensive, not widely available, and involve radiation exposure, creating a need for a simple, reliable surrogate marker that can be incorporated into prognostic systems. Calf circumference (CC) meets these requirements as a practical screening tool with potential future utility within prognostic assessment, pending further validation. AREAS COVERED: A literature search of PubMed, Scopus, Embase, CINAHL, the Cochrane Library, Informed, and the JBI Database of Systematic Reviews (January 2000-November 2025) identified publications on sarcopenia in cirrhosis and the use of CC as a screening tool. International guidelines, systematic reviews, meta-analyses, large observational cohort studies, and narrative reviews were included. This review summarizes the pathophysiology and prognostic relevance of sarcopenia in cirrhosis and evaluates the utility of CC as a cost-effective screening measure with prognostic potential. EXPERT OPINION: CC is a feasible, low-cost surrogate marker of sarcopenia in cirrhosis with potential for integration into prognostic scores. Future studies should focus on validating standardized cutoffs and incorporating CC into prognostic models.