# Non‐Cirrhotic Steatotic Liver Disease is Associated With Impaired Muscle Function: A Cross‐Sectional Study

## TL;DR

This study finds that non-cirrhotic steatotic liver disease is linked to reduced muscle function, suggesting a liver-muscle connection even before cirrhosis.

## Contribution

The study is the first to show impaired muscle function in non-cirrhotic steatotic liver disease patients, independent of age, BMI, and energy balance.

## Key findings

- Muscle strength in SLD patients was significantly lower than in controls, as measured by the liver frailty index and isokinetic dynamometer.
- Both MASLD and ALD subtypes of SLD were associated with impaired muscle function, with ALD showing a higher risk.
- The liver–muscle axis appears disrupted in SLD before cirrhosis, independent of age, gender, and energy balance.

## Abstract

Impaired muscle function is frequent in cirrhosis and potentially participates in liver disease progression. Data from non‐cirrhotic patients with steatotic liver disease (SLD) are lacking. Our aims were to determine if muscle function was impaired in a non‐cirrhotic cohort of patients with SLD and if the SLD subtype and severity were associated with impaired muscle function.

Patients with SLD and controls were prospectively recruited. Liver disease was assessed by imaging, vibration‐controlled transient elastography and non‐invasive tests. Muscle function was assessed by the liver frailty index (LFI) and isokinetic dynamometer. Diet and physical activity habits were recorded using dedicated questionnaires to measure the energetic balance.

One‐hundred and fifty patients with non‐cirrhotic SLD (75 patients with metabolic dysfunction‐associated steatotic liver disease [MASLD] and 75 patients with alcohol‐related liver disease [ALD]) and 30 non‐SLD controls were prospectively recruited. The LFI negatively correlated to lower limb muscle strength assessed by isokinetic dynamometer in all participant groups (r = 0.82 in the control group; r = 0.69 in the pooled SLD group—p < 0.0001). Both SLD groups showed muscle strength impairment assessed by the LFI compared to age‐ and gender‐matched controls. In multivariate analysis, the presence of SLD was associated with impaired muscle function independently of age, BMI and energetic balance, with a higher risk related to ALD.

Patients with SLD already show impaired muscle function compared to controls independently of age, gender and energetic balance. Taken together, our data support a potential disruption of the liver–muscle axis already occurring in SLD prior to cirrhosis.

ClinicalTrials.gov identifier: NCT06514300