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Peer-reviewedCC BYMedComm

Associations of Coexisting Metabolic Dysfunction‐Associated Steatotic Liver Disease and Sarcopenia‐Related Abnormalities With Adverse Clinical Outcomes Across Obesity States

  • Hong Fan1
  • Xianhua Mao1
  • Taotao Yan1
  • Scott Barnett1
  • Jing Zhang2
  • Ramsey Cheung1
  • Xuehong Zhang3
  • Mindie H. Nguyen1
  1. 1Stanford University Medical Center
  2. 2Beijing Youan Hospital Capital Medical University
  3. 3Harvard T.H. Chan School of Public Health
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Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with adverse liver and non-liver outcomes, but the impact of coexisting sarcopenia-related abnormalities (e.g., low muscle strength [MS], muscle mass, and physical performance) remains unclear. In a prospective UK Biobank cohort (n = 438,748), we evaluated their joint associations with incidence and risks of all-cause mortality, cirrhosis, hepatocellular carcinoma (HCC), cardiovascular disease (CVD), chronic kidney disease (CKD), non-liver cancers, and obesity-related cancers across MASLD and sarcopenia-related abnormality status. Over a median follow-up of 13.8 years, 401 HCC, 1714 cirrhosis, 39,534 CVD, 19,637 CKD, 38,240 non-liver cancers, 12,536 obesity-related cancers, and 34,801 deaths occurred. A stepwise increase in both incidence and adjusted risk of liver and non-liver outcomes was observed across MASLD and sarcopenia strata. Within the coexistence group, the obesity (vs. non-obesity) subgroup generally had higher risks. For example, for cirrhosis, adjusted hazard ratios increased from 3.93 to 7.36 then 8.48 with MASLD alone, coexisting MASLD with low MS overall and coexisting MASLD, low MS and obesity, respectively. Similar findings were observed in external validation analyses using the 2011-2018 US National Health and Nutrition Examination Survey cohort. Together, these observations inform risk stratification strategy and management of MASLD to include sarcopenia assessment.

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Cite

BibTeXRIS
BibTeX
@article{fan2026associations,
  title = {{Associations of Coexisting Metabolic Dysfunction‐Associated Steatotic Liver Disease and Sarcopenia‐Related Abnormalities With Adverse Clinical Outcomes Across Obesity States}},
  author = {Hong Fan and Xianhua Mao and Taotao Yan and Scott Barnett and Jing Zhang and Ramsey Cheung and Xuehong Zhang and Mindie H. Nguyen},
  journal = {MedComm},
  year = {2026},
  month = oct,
  doi = {10.1002/mco2.71111},
  url = {https://europepmc.org/article/PMC/PMC13718951},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Associations of Coexisting Metabolic Dysfunction‐Associated Steatotic Liver Disease and Sarcopenia‐Related Abnormalities With Adverse Clinical Outcomes Across Obesity States
AU  - Hong Fan
AU  - Xianhua Mao
AU  - Taotao Yan
AU  - Scott Barnett
AU  - Jing Zhang
AU  - Ramsey Cheung
AU  - Xuehong Zhang
AU  - Mindie H. Nguyen
PY  - 2026
DA  - 2026/10/29
JO  - MedComm
DO  - 10.1002/mco2.71111
UR  - https://europepmc.org/article/PMC/PMC13718951
AB  - Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with adverse liver and non-liver outcomes, but the impact of coexisting sarcopenia-related abnormalities (e.g., low muscle strength [MS], muscle mass, and physical performance) remains unclear. In a prospective UK Biobank cohort (n = 438,748), we evaluated their joint associations with incidence and risks of all-cause mortality, cirrhosis, hepatocellular carcinoma (HCC), cardiovascular disease (CVD), chronic kidney disease (CKD), non-liver cancers, and obesity-related cancers across MASLD and sarcopenia-related abnormality status. Over a median follow-up of 13.8 years, 401 HCC, 1714 cirrhosis, 39,534 CVD, 19,637 CKD, 38,240 non-liver cancers, 12,536 obesity-related cancers, and 34,801 deaths occurred. A stepwise increase in both incidence and adjusted risk of liver and non-liver outcomes was observed across MASLD and sarcopenia strata. Within the coexistence group, the obesity (vs. non-obesity) subgroup generally had higher risks. For example, for cirrhosis, adjusted hazard ratios increased from 3.93 to 7.36 then 8.48 with MASLD alone, coexisting MASLD with low MS overall and coexisting MASLD, low MS and obesity, respectively. Similar findings were observed in external validation analyses using the 2011-2018 US National Health and Nutrition Examination Survey cohort. Together, these observations inform risk stratification strategy and management of MASLD to include sarcopenia assessment.
SN  - 2688-2663
ER  -