Sarcopenia and MASLD: novel insights and the future

Chang-Hai Liu^#^{1

2}, Qing-Min Zeng^#^{1

2}, Won Kim^{3

4}, Seung Up Kim^{5

6}, Zobair M Younossi^{7

8

9}, Giovanni Targher^{10

11}, Christopher D Byrne¹², Christos S Mantzoros^{13

14}, Phunchai Charatcharoenwitthaya¹⁵, Isabelle Anne Leclercq¹⁶, Manuel Romero-Gómez¹⁷, Hong Tang^{18

19}, Ming-Hua Zheng^{20

21}

Affiliations

¹ Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
² Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
⁵ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
⁶ Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
⁷ Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA.
⁸ Inova Medicine, Inova Health System, Falls Church, VA, USA.
⁹ Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
¹⁰ Department of Medicine, University of Verona, Verona, Italy.
¹¹ Metabolic Diseases Research Unit, IRCCS Sacro Cuore-Don Calabria Hospital, Verona, Italy.
¹² Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton General Hospital, Southampton, UK.
¹³ Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Internal Medicine, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA.
¹⁵ Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁶ Laboratory of Hepato-Gastroenterology, Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium.
¹⁷ Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver group at Institute of Biomedicine of Seville, University of Seville, Seville, Spain.
¹⁸ Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China. tanghong6198@wchscu.cn.
¹⁹ Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China. tanghong6198@wchscu.cn.
²⁰ MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. zhengmh@wmu.edu.cn.
²¹ Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China. zhengmh@wmu.edu.cn.

^# Contributed equally.

PMID: 41193695
DOI: 10.1038/s41574-025-01197-7

Review

Sarcopenia and MASLD: novel insights and the future

Chang-Hai Liu et al. Nat Rev Endocrinol. 2025.

. 2025 Nov 5.

doi: 10.1038/s41574-025-01197-7. Online ahead of print.

Authors

Affiliations

¹ Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
² Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
³ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
⁵ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
⁶ Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
⁷ Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA.
⁸ Inova Medicine, Inova Health System, Falls Church, VA, USA.
⁹ Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
¹⁰ Department of Medicine, University of Verona, Verona, Italy.
¹¹ Metabolic Diseases Research Unit, IRCCS Sacro Cuore-Don Calabria Hospital, Verona, Italy.
¹² Southampton National Institute for Health and Care Research Biomedical Research Centre, University Hospital Southampton and University of Southampton, Southampton General Hospital, Southampton, UK.
¹³ Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Internal Medicine, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA.
¹⁵ Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁶ Laboratory of Hepato-Gastroenterology, Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium.
¹⁷ Digestive Diseases Unit, Virgen del Rocío University Hospital, SeLiver group at Institute of Biomedicine of Seville, University of Seville, Seville, Spain.
¹⁸ Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China. tanghong6198@wchscu.cn.
¹⁹ Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China. tanghong6198@wchscu.cn.
²⁰ MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. zhengmh@wmu.edu.cn.
²¹ Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China. zhengmh@wmu.edu.cn.

^# Contributed equally.

PMID: 41193695
DOI: 10.1038/s41574-025-01197-7

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD; previously known as non-alcoholic fatty liver disease) is the leading cause of chronic liver disease worldwide and is closely linked to the obesity epidemic. MASLD often coexists with sarcopenia, an age-related loss of muscle mass and muscle function. These conditions are closely connected, and metabolic syndrome and its associated metabolic factors have a crucial role in their relationship. Metabolic syndrome considerably affects the risk and progression of MASLD and sarcopenia and promotes their development through various mechanisms. This Review explores the epidemiological link between MASLD and sarcopenia and the effect of metabolic syndrome and its components on both conditions, summarizing current treatment strategies and emerging evidence. To effectively manage both MASLD and sarcopenia, it is crucial to incorporate the five metabolic risk factors of metabolic syndrome into risk assessment and treatment strategies. Future research should continue to investigate the mechanisms linking metabolic syndrome, MASLD and sarcopenia. Establishing standardized definitions of sarcopenia for patients with MASLD and developing personalized treatment strategies through precision medicine will improve diagnosis, interventions and overall patient outcomes.

PubMed Disclaimer

Conflict of interest statement

Competing interests: M.-H.Z. has received honoraria for lectures from AstraZeneca, Hisky Medical Technologies and Novo Nordisk, and consulting fees from Boehringer Ingelheim and serves as a consultant for Eieling Technology. C.S.M. reports grants through his institution from Merck, Massachusetts Life Sciences Center and Boehringer Ingelheim, has received grants through his institution and personal consulting fees from Coherus Inc. and AltrixBio, reports personal consulting fees and support with research reagents from Ansh Inc., collaborative research support from LabCorp Inc., personal consulting fees from Olympus, Genfit, Lumos, Novo Nordisk, Amgen, Biodexa, Laekna, Corcept, Intercept, 89 Bio, Madrigal, Aligos, Esperion and Regeneron, travel support and fees from UptoDate, TMIOA, Elsevier and the Cardio Metabolic Health Conference. C.D.B. has received grant support from Echosens. W.K. reports grants from Glaxosmithkline, Gilead, Novartis, Pfizer, Roche, Springbank, Ildong, Galmed, Dicerna, Enyo, Hanmi, Novo Nordisk and KOBIOLABS; consulting fees from Boehringer Ingelheim, Novo Nordisk, Standigm, Daewoong, TSD Life Sciences Ildong, Olix Pharma, HK Inoen and KOBIOLABS; honoraria for lectures from Ildong, Samil and Novo Nordisk, owns stocks in KOBIOLABS and Lepidyne, and is the founder of Remedygen. S.U.K. reported honoraria from Gilead Sciences, GSK, Bayer, Eisai, AbbVie, EchoSens, MSD, BMS and AstraZeneca and grants from AbbVie, BMS and Gilead. The other authors declare no competing interests.

References

1. Riazi, K. et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol. 7, 851–861 (2022). - PubMed - DOI
1. Younossi, Z. M. et al. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology 77, 1335–1347 (2023). - PubMed - DOI
1. Feng, G. et al. Recompensation in cirrhosis: unravelling the evolving natural history of nonalcoholic fatty liver disease. Nat. Rev. Gastroenterol. Hepatol. 21, 46–56 (2024). - PubMed - DOI
1. Kitamura, A. et al. Sarcopenia: prevalence, associated factors, and the risk of mortality and disability in Japanese older adults. J. Cachexia Sarcopenia Muscle 12, 30–38 (2021). - PubMed - DOI
1. Dajti, E. et al. Sarcopenia evaluated by EASL/AASLD computed tomography-based criteria predicts mortality in patients with cirrhosis: a systematic review and meta-analysis. JHEP Rep. 6, 101113 (2024). - PubMed - PMC - DOI

Publication types

Actions

LinkOut - more resources

Full Text Sources
- Nature Publishing Group

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Sarcopenia and MASLD: novel insights and the future

Affiliations

Sarcopenia and MASLD: novel insights and the future

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

LinkOut - more resources

Full Text Sources