Evaluation of Sarcopenic Obesity in Patients with MASLD

Sarcopenic obesity (SO) has gained growing attention in metabolic dysfunction-associated steatotic liver disease (MASLD), yet data in Caucasian populations remain limited. The aim of the study was to assess the prevalence of SO using different definitions and to explore its relationship with steroid androgens, physical performance and frailty in MASLD individuals. Two hundred Caucasian patients with MASLD and available dual-energy X-ray absorptiometry (DEXA) data were evaluated. Clinical, biochemical, hormonal and elastography data were recorded, while physical performance was assessed using the Short Physical Performance Battery (SPPB) and Liver Frailty Index (LFI). SO prevalence ranged from 34.5% to 76.5% based on different SO definitions. SO individuals showed greater hepatic steatosis, more metabolic comorbidities and demonstrated poorer physical performance. Lower dehydroepiandrosterone sulfate (DHEAS) levels were independently associated with SO when definition is based on total body fat percentage, and waist circumference (WC) was consistently linked to SO across all definitions. Separate analysis based on gender, confirmed DHEAS being independently associated with SO in men, while WC represented an independent SO predictor in both genders. In conclusion, SO is common among Caucasian MASLD patients and is accompanied by metabolic, hepatic, hormonal, and functional alterations, highlighting the need for better identification in clinical practice.