Association of age-adjusted skeletal muscle index and modest alcohol intake with hepatic steatosis and fibrosis in males

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern linked to obesity, insulin resistance, and metabolic syndrome. Although body composition and alcohol intake influence disease progression, their specific associations with hepatic steatosis and fibrosis remain unclear.Methods: Males (n = 174) with MASLD were evaluated. Hepatic steatosis and fibrosis were assessed using the controlled attenuation parameter (CAP) and liver stiffness measurement using transient elastography. Skeletal muscle index (SMI) and visceral fat area (VFA) were determined using bioelectrical impedance analysis. The participants were stratified according to alcohol consumption (< 30 g/d vs. none). Multivariate logistic regression was used to identify the factors independently associated with severe steatosis and advanced fibrosis.Results: Severe steatosis was associated with higher body mass index, VFA, fat mass, and SMI. Factors independently associated with severe steatosis were modest alcohol intake, higher SMI Z-scores, and elevated triglyceride levels. In non-drinkers, a higher SMI Z-score remained significant. Advanced fibrosis was associated with a higher SMI Z-score and plasma aspartate aminotransferase levels, whereas moderate alcohol consumption and higher platelet count were inversely associated. The SMI Z-score positively correlated with both CAP and fibrosis severity.Conclusions: A higher age-adjusted SMI was independently associated with a greater severity of hepatic steatosis and fibrosis, whereas modest alcohol intake was inversely associated with the presence of advanced fibrosis in male patients with MASLD.