MSTN and laryngotracheoesophageal cleft: The mechanism of sarcopenia in LC patients was reported to involve protein-energy malnutrition (PEM, as defined by hypoalbuminemia and low non-protein respiratory quotient, as assessed by indirect calorimetry), which is characteristic of cirrhotic patients, signaling related to protein synthesis and degradation, dysbiosis and myokines such as myostatin (cytokine with the inhibition of muscle protein synthesis), the ubiquitin-proteasome pathway, insulin resistance and the sex hormone (testosterone, etc.)[18,19,20,21].