IGF1 and hepatocellular carcinoma: One major cause of sarcopenia and fragility is the alteration of the endocrine system involved in the inflammatory processes, muscle synthesis, and protein catabolism.[17] Decrease of insulin-like growth factor-1 (IGF-1) is strongly associated with low muscle mass and muscle strength.[18] Patients with HCC have lower IGF-1 levels than those with cirrhosis or healthy people.