# Metabolic Dysfunction-Associated Steatotic Liver Disease and Sarcopenia: Review of Literature

## TL;DR

This paper reviews the connection between liver disease caused by metabolic issues and muscle loss, highlighting their mutual impact and potential for a harmful cycle.

## Contribution

The paper provides a comprehensive review of the bidirectional relationship between MASLD and sarcopenia, emphasizing their interplay and clinical implications.

## Key findings

- MASLD and sarcopenia are strongly correlated through insulin resistance and liver fibrosis.
- Secondary sarcopenia in chronic liver disease is linked to metabolic and nutritional disorders.
- Aging and primary sarcopenia may worsen outcomes in MASLD due to their bidirectional relationship.

## Abstract

In 2023, the terminology of metabolic dysfunction-associated steatotic liver disease (MASLD) was proposed. MASLD uses metabolic abnormalities as an inclusion criterion. On the other hand, sarcopenia is defined by decrease in muscle mass and muscle strength. Skeletal muscle can be affected by insulin resistance (IR), and it is the largest site of insulin-stimulated glucose disposal. In recent years, advances in treatment have extended the life expectancy of patients with chronic liver disease (CLD). Due to the aging population, aging-related primary sarcopenia is expected to increase. On the other hand, liver fibrosis is an important treatment target associated with the onset of serious adverse events and poor prognosis in MASLD. The liver is the central organ for nutrition and metabolism, and patients with CLD may develop secondary sarcopenia due to various nutritional and metabolic disorders unrelated to aging. There is a strong correlation between sarcopenia, muscle fatty degeneration, liver fibrosis and IR in MASLD. MASLD and sarcopenia have a bidirectional relationship, forming a vicious cycle. In this review, we will summarize the relationship between MASLD and sarcopenia based on the current knowledge.