Sarcopenia and Metabolic Dysfunction Associated Steatotic Liver Disease: A critical review with structured synthesis of published meta analyses

Sarcopenia and metabolic dysfunction-associated steatotic liver disease may coexist through shared metabolic, inflammatory, and behavioral pathways. However, evidence connecting muscle impairment to steatosis and fibrosis is complicated by changing liver nomenclature and inconsistent muscle definitions. This review critically synthesizes PubMed-indexed clinical publications verified on 7 October 2026, emphasizing published meta-analyses and selected longitudinal and biopsy-based studies. Review-level estimates were displayed in their original outcome direction and were not pooled across overlapping evidence bases. Published syntheses generally associated sarcopenia with prevalent fatty liver disease and with higher odds of liver fibrosis, although effect sizes differed substantially. A 2026 synthesis reported associations of 1.58 for fatty liver disease and 2.03 for concomitant fibrosis; earlier reviews reported smaller or less precise estimates. Regional and diagnostic-method differences limit universal interpretation. Much of the literature defines sarcopenia through low relative muscle mass without the strength and performance assessments required by contemporary clinical frameworks. Historical NAFLD populations were therefore discussed as relevant to MASLD without assuming complete diagnostic equivalence. Longitudinal studies support temporal relationships between relative muscle mass and liver outcomes but do not establish that increasing muscle reverses fibrosis. Integrated assessment of muscle function, adiposity, metabolic health, and validated liver fibrosis measures is justified. Prospective intervention studies using contemporary definitions are needed to determine whether muscle-directed care improves hepatic outcomes.