The Associations Between the Skeletal Muscle Mass-to-Visceral Fat Area Ratio (SVR) and Risk of Liver Steatosis and Liver Fibrosis: A Systematic Review and Meta-Analysis

Abstract

Changes in the visceral fat area (VFA) and skeletal muscle mass (SMM) play important roles in NAFLD development. The SMM to VFA ratio (SVR) is a new index, and the link between the SVR and NAFLD is still unclear. Therefore, we conducted a systematic review with meta-analysis to investigate the association between the SVR and the risk of liver steatosis and liver fibrosis in adult participants. A comprehensive search of electronic databases (Web of Science, PubMed/Medline, Scopus) was conducted to identify relevant studies up to May, 2025. The Odds ratios (OR) were extracted from the eligible studies, and a meta-analysis was performed to calculate the pooled effect size. About 10 papers, including 15 studies, were included in the meta-analysis. Among them, 15 studies reported effect sizes for the risk of liver steatosis, and five studies reported effect sizes for the risk of liver fibrosis. A significant inverse association was observed between SVR and liver steatosis and liver fibrosis (OR: 0.19, 95% confidence interval (CI): 0.11–0.35, OR: 0.50, 95% CI: 0.29–0.86). Subgroup analysis based on sex and body mass index (BMI) revealed no statistically significant differences between groups (sex: P = 0.862; weight categories: P = 0.474), indicating that these factors did not contribute to heterogeneity in our study. The point estimates for the association between SVR and liver steatosis appeared somewhat more favorable in nonobese participants and female participants, though these differences were not statistically significant. In summary, our findings show an association between higher SVR and lower risk of both liver steatosis and fibrosis. The relationship with liver steatosis appears consistent across gender and BMI subgroups, with no statistically significant differences observed between groups.

PROSPERO Registration: CRD420251072087.