Metabolic-associated fatty liver disease and sarcopenia: A double whammy

Table 1 Sarcopenia as a risk factor for metabolic-associated fatty liver disease

Ref.	Study design	Study population	Size	Sarcopenic assessment	MAFLD assessment	Conclusions
Seo et al[17], 2022	Longitudinal	Korean	115568	BIA	Non-invasive models	Increases in relative skeletal muscle mass over time may lead to benefits in prevention of development of NAFLD or the resolution of existing NAFLD
Zhai et al[18], 2018	Cross-sectional	Chinese	494	DXA	US	NAFLD is not independently associated with sarcopenia
Wijarnpreecha et al[19], 2019	Cross-sectional	American	11325	BIA	US	Sarcopenia was independently associated with increased odds of NAFLD and NAFLD-associated advanced fibrosis independent of well-defined risk factors
Hsieh et al[20], 2021	Cross-sectional	Korean	521	CT	Liver biopsy	Patients with significant fibrosis had lower Skeletal muscle index and muscle attenuation than those without
Zhao et al[21], 2023	Cross-sectional	American	2065	DXA	LUTE	Higher appendicular skeletal muscle mass was associated with a lower risk of MAFLD, while the risk of significant fibrosis in females was increased with the trunk skeletal muscle mass
Hsieh et al[22], 2023	Longitudinal	Korean	338	CT	Liver biopsy	Severe myosteatosis is significantly associated with early NASH and fibrosis progression in early-stage MAFLD
Tanaka et al[23], 2020	Cross-sectional	Japanese	632	CT	Non-invasive models	Both skeletal muscle index and skeletal muscle density are independently associated with the prevalence of MAFLD
Choe et al[24], 2023	Cohort	Korean	4038	BIA	Non-invasive models	Both lower muscle mass index and genetic risk variants are important contributors to the development of MAFLD

BIA: Bioimpedance analysis; DXA: Dual Xray absorptiometry; LUTE: Liver ultrasound transient elastography; MAFLD: Metabolic-associated fatty liver disease; NAFLD: Non-alcoholic fatty liver disease; US: Ultrasonography.

Table 2 Metabolic-associated fatty liver disease as a risk factor for sarcopenia[28]

Ref.	Study design	Study population	Size	Sarcopenic assessment	MAFLD assessment	Conclusions
Roh et al[25], 2022	Longitudinal	Korean	1595	DXA	Non-invasive models	The presence of NAFLD may predict future risk of low muscle mass and low muscle strength, with a greater impact on LMS than on LMM
Sinn et al[26], 2022	Cross-sectional	Korean	52815	BIA	US	Participants with NAFLD were at increased risk of sarcopenia, indicated by faster loss of skeletal muscle mass
Altajar et al[27], 2023	Cross-sectional	Korean	6414	BIA	CAP	The presence of MAFLD is significantly associated with an increased risk of low muscle mass with varying risks according to the MAFLD subgroups

BIA: Bioimpedance analysis; DXA: Dual Xray absorptiometry; LUTE: Liver ultrasound transient elastography; MAFLD: Metabolic-associated fatty liver disease; NAFLD: Non-alcoholic fatty liver disease; US: Ultrasonography; CAP: Controlled attenuation parameter; LMM: Low muscle mass; LMS: Low muscle strength.