Incidence, prevalence, and prognostic impact of sarcopenia on hepatic and cardiovascular outcomes in non-cirrhotic metabolic dysfunction–associated steatotic liver disease

Background and aim Sarcopenia is increasingly recognized as a clinically relevant comorbidity in metabolic dysfunction–associated steatotic liver disease (MASLD), yet its epidemiology and prognostic implications in non-cirrhotic disease remain incompletely characterized. We aimed to evaluate temporal trends in the incidence and prevalence of sarcopenia among patients with MASLD and to assess its association with hepatic and cardiovascular outcomes. Methods We conducted a retrospective longitudinal cohort study of adults with MASLD diagnosed between 2005 and 2024 using a large, nationwide electronic health record network. Annual incidence and prevalence of sarcopenia were examined over time. Non-cirrhotic MASLD patients with sarcopenia were compared with non-sarcopenic controls using 1:1 propensity score matching to balance demographic characteristics, metabolic comorbidities, cardiovascular risk factors, and medication use. Hepatic and cardiovascular outcomes were evaluated using Kaplan–Meier analyses and Cox proportional hazards models. Results Among 1,232,337 patients with MASLD, 714 had documented sarcopenia. Both incidence and prevalence of sarcopenia increased steadily over the study period, with comparable trends across sexes. After propensity score matching, sarcopenia was associated with significantly higher odds of cirrhosis (OR 4.46), hepatic decompensation (OR 5.18), and all-cause mortality (OR 2.36). Sarcopenic MASLD patients also demonstrated increased risk of major adverse cardiovascular events, including heart failure, ischemic heart disease, atrial fibrillation, cerebrovascular events, and thrombotic disorders. On time-to-event analysis, sarcopenia independently predicted hepatic outcomes (HR 5.03) and cardiovascular outcomes (HR 2.24). Conclusion Sarcopenia is an increasingly prevalent condition in MASLD and a powerful independent predictor of adverse hepatic and cardiovascular outcomes in non-cirrhotic disease. These findings underscore the importance of early identification and targeted management of sarcopenia to improve long-term outcomes in MASLD.