The presence of sarcopenia at baseline seems to affect the fibrosis amelioration in patients with metabolic dysfunction associated steatotic liver disease

Introduction Sarcopenia, defined as the loss of muscle mass, is linked to metabolic comorbidities, connecting to steatotic liver disease and cardiovascular damage (CVD). The impact of sarcopenia on liver and CVD progression over time is not well understood. Aim To evaluate the impact of baseline sarcopenia on liver and CVD progression after 5 years in non-cirrhotic metabolic dysfunction-associated liver disease (MASLD) patients. Methods 178 patients (62% male, mean age 51±10 years) were enrolled. Sarcopenia was defined as skeletal muscle mass/height2 ≤ 10.7/7.5 kg/m2 in men/women by bioimpedance analysis. CVD was assessed by carotid plaques or increased intima-media thickness (cIMT) > 0.9 mm at ultrasound, liver fibrosis by liver stiffness measurement (LSM) at Fibroscan and severity of steatosis (grade 2 -3) at ultrasound. After 5 years, liver disease and CVD severity were reassessed. Results At baseline 45% were sarcopenic, 35% obese, 39% hypertensive, 25% dyslipidemic, 12% diabetic, sarcopenic patients compared to non-sarcopenic were more prevalently males (p=0.04), had lower BMI (26.5 vs 30.8, p<0.001), lower waist circumference (97 vs 105, p<0.001), greater LSM (5.4 vs 4.9 p=0.01), but similar prevalence of carotid plaques (p=0.88). At 5 yrs of follow-up, despite life-style modification, sarcopenic patients maintained lower BMI (26.5 vs 30.8, p<0.001) with no differences in deltaBMI (p=0.10), showed less improvement in low-density lipoprotein (LDL) (9.7 vs 27.9, p=0.04) despite of lipid-lowering lipid drugs use, a less improvement in LSM (0.1 vs 0.7, p=0.04), with no differences in carotid plaques (p=0.97) and increased cIMT (p=0.88). At multivariate analysis, deltaLSM remained associated with sarcopenia (OR 1.86, p=0.04), irrespective of confounders. Conclusions Baseline sarcopenia seems to be related to less improvement in liver damage. Despite lower visceral adiposity, sarcopenic patients had greater LSM values, with the same extent of CV damage. SLD patients should be screened for sarcopenia to prevent liver disease progression.