## 3 Perspectives and Outcomes of the Presented RHMS with a Focus on Diet-Related Approaches
### Nutritional Status Evaluation  
Malnutrition is one of the most common and potentially reversible complications of LC and increases the risk of morbidity and mortality. All patients with chronic liver impairment and, in particular, patients with decompensated LC should undergo nutritional assessment to confirm the presence and determine the severity of malnutrition so that personalized interventions can be promptly instituted. The lack of validated rapid screening tools and constant challenges in interpreting body composition and laboratory results in the presence of volume overload and liver dysfunction are the main reasons why nutritional screening and assessment are not routinely performed in patients with LC [123]. For all patients, especially for those at risk of malnutrition, a detailed nutritional assessment is required and typically includes physical examination, assessment of additional risk factors like smoking and alcohol consumption, laboratory testing for macro- and micronutrient deficiencies, global assessment tools for frailty and deconditioning, and body composition testing. Recent weight loss, loss of appetite, nausea, altered taste or smell, abdominal distension and/or pain, altered intestinal transit, and specific signs and symptoms of vitamin deficiency should be routinely assessed and, if present, should trigger immediate intervention to prevent further denitrification. The most accessible but imperfect screening tool for malnutrition in LC is the body mass index (BMI), derived from a combination of anthropometric indices (height and weight in kg); a value of <18.5 kg/m2 and the classification of LC as class C (the most severe) according to the Child-Pugh classification should immediately trigger additional nutritional screening [124]. However, in patients with sarcopenia obesity (in whom excess adipose tissue may mask the underlying loss of muscle mass) and in patients with volume overload (ascites and oedema), the BMI is suboptimal in determining the nutritional status, as it does not provide information regarding body mass composition and lean body mass. Determining muscular mid-arm circumference and tricipital skinfold thickness are alternative rapid tools to determine weight and muscle loss, but the optimal methods for body composition analysis are cross-sectional imaging (including computed tomography or magnetic resonance imaging) and bioelectrical impedance analysis. Cross-sectional imaging is currently the gold standard for the evaluation of sarcopenia [125], as it allows for direct and standardized assessment of muscle mass (through skeletal muscle index or psoas muscle index), being especially useful in patients with sarcopenia obesity. 1.2 Potential of RHMS (HepatoConect System) Capabilities for Liver Cirrhosis Management: Telentutrition, Nutrition Intervention, and Education Strategies  
Innovations in digital health should play a key role in standardising the management of liver disease and eliminating potential quality gaps. Although efforts have been made to develop quality standards of care for patients with this condition, there are still wide variations in clinical practice. Moreover, nutritional evaluation and nutrition intervention are extremely important but poorly addressed aspects of the management of LC. The American Association for the Study of Liver Disease developed a series of measures to improve the quality of care for patients with LC in the management of ascites,oesophageal vertices, hepatic encephalopathy, screening for hepatocellular carcinoma, and evaluation for liver transplantation [126]. However, some studies show that less than one-third of patients with LC receive all the recommended care for ascites [127], and even fewer patients receive all the care needed for the screening and management of gastroesophageal varices [128].