Relationship between metabolic dysfunction-associated steatotic liver disease and sarcopenia: A systematic review and meta-analyses

Ninglin Xia; Jiwei Wang; Qian Lu; Xue Fan; Zhenzhou Jiang; Qinwei Yu

doi:10.1016/j.clnesp.2025.06.027

Relationship between metabolic dysfunction-associated steatotic liver disease and sarcopenia: A systematic review and meta-analyses

Clin Nutr ESPEN. 2025 Jun 14:68:679-690. doi: 10.1016/j.clnesp.2025.06.027. Online ahead of print.

Authors

Ninglin Xia¹, Jiwei Wang¹, Qian Lu¹, Xue Fan¹, Zhenzhou Jiang², Qinwei Yu³

Affiliations

¹ New Drug Screening and Pharmacodynamics Evaluation Center, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China.
² New Drug Screening and Pharmacodynamics Evaluation Center, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China; Key Laboratory of Drug Quality Control and Pharmacovigilance, Ministry of Education, China Pharmaceutical University, Nanjing 210009, China; Jiangsu Key Laboratory of Drug Gability of Biopharmaceuticals, China Pharmaceutical University, Nanjing 210009, China. Electronic address: beaglejiang@cpu.edu.cn.
³ New Drug Screening and Pharmacodynamics Evaluation Center, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing 210009, China. Electronic address: yuqinwei7213@cpu.edu.cn.

PMID: 40523474
DOI: 10.1016/j.clnesp.2025.06.027

Abstract

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) and Sarcopenia are highly prevalent health conditions in the world. Our objective was designed to quantify the relationship between the diagnosis of sarcopenia, sarcopenia and the risk of MASLD.

Methods: Web of Science, PubMed, Embase, and OVID were systematically searched from inception to 10 March, 2024, to identify all relevant studies.

Results: 63 studies met the inclusion criteria, encompassing 288,583 participants. Our findings revealed that the risk of MASLD increased in subjects with sarcopenia (OR: 1.37, [95%CI 1.23,1.51]). In MASLD patients, the levels of skeletal muscle index (SMI) (SMD: -0.26, [95%CI -0.34, -0.18]) and gait speed (SMD: -0.17, [95%CI -0.27, -0.06]) were lower than in normal individuals. Moreover, a higher risk of MASLD was associated with decreased SMI (OR: 0.73, [95%CI 0.66, 0.79], decreased muscle strength (OR: 0.97, [95%CI 0.93, 1.00]). Additionally, the risk of advanced liver fibrosis (OR: 1.47, [95%CI 1.23,1.71]), mortality rate (RR: 1.15, [95%CI 1.09, 1.20]) and all-cause mortality (HR: 1.30, [95%CI 1.13,1.47]) increased in MASLD patients with sarcopenia.

Conclusion: Sarcopenia individuals have higher occurrence risk of MASLD. Meanwhile, the patients with low SMI and low muscle strength have higher occurrence risk of MASLD. Furthermore, sarcopenia individuals have higher occurrence risk of MASLD advanced stages including liver fibrosis or mortality. Our study suggested that clinicians should be vigilant about symptoms of sarcopenia, such as SMI, gait speed and muscle strength in patients with MASLD, detect susceptible populations early, and reduce the risk of poor prognosis.

Keywords: Advanced liver fibrosis; MASLD; Muscle strength; Sarcopenia; Skeletal muscle mass index; Walk speed.