Sarcopenia and Frailty in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: The Impact of Steroid Hormones

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to sarcopenia and frailty, but data on white populations remain limited. This study evaluated sarcopenia, physical performance and steroid hormone associations with frailty in European MASLD patients. A cross-sectional study included 245 white MASLD patients. Clinical, biochemical, hormonal and elastography data were collected. Sarcopenia was assessed using dual-energy X-ray absorptiometry alongside mid-arm muscle circumference (MAMC), while physical performance was assessed using the liver frailty index (LFI) and the short physical performance battery (SPPB). Mean age was 56.2 years, 45.7% were male, and median liver stiffness was 5.2 kPa; 76.3% and 33.9% of patients had low MAMC and Appendicular Lean Mass Index, while 13.5% had abnormal SPPB and 16% were frail (i.e., LFI > 4.4). Poor physical performance was linked to lower dehydroepiandrosterone sulfate (DHEAS) levels using both LFI (OR: 0.98, 95% C.I.: 0.96–0.99, p = 0.01) and SPPB (OR: 1.14, 95% C.I.: 1.003–1.22, p = 0.026). Frailty assessed by LFI was associated with increased liver stiffness (OR: 1.24, 95% C.I.: 1.047–1.482, p = 0.013). We concurrently evaluated muscle mass and frailty for the first time in a white MASLD cohort. Lower DHEAS levels were associated with impaired physical performance. Further studies are needed to confirm these findings and their possible therapeutic implications.