SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
Sarcopenia as a Risk Factor for Nonalcoholic Fatty Liver Disease and Liver Fibrosis: An updated Systematic Review and Meta-analysis
Xinrong Zuo 1
Doudou Chen 2
Yi Kang 1
Xinyi Hu 1
Yarong Zhang 3
Kuo Tang 1
Junhua Shi 2
Tao Li 1
Wangning ShangGuan 2
1. West China Hospital, Sichuan University, Chengdu, China
2. The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
3. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Abstract
Background: Sarcopenia, an age-related skeletal muscle disorder with metabolic dysregulation, has been linked to various chronic diseases. Emerging evidence suggests a bidirectional relationship with nonalcoholic fatty liver disease (NAFLD), though the epidemiological and mechanistic links remain unclear. This study aimed to assess the prevalence of sarcopenia in NAFLD populations and its association with NAFLD and liver fibrosis. Methods: PubMed, EMBASE, MEDLINE, Cochrane Library, and Web of Science databases were searched for eligible studies published until August 6, 2025. Two validated tools assessed the study quality and risk of bias. Statistical analyses were conducted using STATA 17.0. This study has been registered on PROSPERO (CRD420251021280). Results: From 4,938 screened records, 41 studies (n=185,575) were retrieved. The prevalence of sarcopenia in patients with NAFLD varied substantially (0.8% to 80.9%), with a pooled estimate significantly higher than that in non-NAFLD controls 23% (95% CI: 20% to 26%) vs. 15% (95% CI: 13% to 17%). Meta-analysis revealed that sarcopenia was associated with a 1.58-fold increased risk of NAFLD (95% CI: 1.37 to 1.82) and a 2.03-fold risk of concomitant liver fibrosis (95% CI: 1.54 to 2.68). Subgroup analyses showed that the association was consistent across different muscle mass assessment methods, but varied by NAFLD diagnostic modality. CT-based NAFLD diagnosis yielded the highest aORs, while transient elastography showed a nonsignificant association. Conclusions: This study confirms a high prevalence of sarcopenia in NAFLD populations and a significant association with NAFLD and liver fibrosis, supporting its role as a modifiable risk factor. However, heterogeneity due to diagnostic variability remains a limitation. Standardized criteria and longitudinal studies are needed to establish causality. Keywords: sarcopenia; nonalcoholic fatty liver disease; metabolic dysfunction-associated steatotic liver disease; hepatic fibrosis; prevalence
Summary
Keywords
hepatic fibrosis, Metabolic dysfunction-associated steatotic liver disease, nonalcoholic fatty liver disease, Prevalence, Sarcopenia
Received
16 October 2025
Accepted
18 February 2026
Copyright
© 2026 Zuo, Chen, Kang, Hu, Zhang, Tang, Shi, Li and ShangGuan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Tao Li; Wangning ShangGuan
Disclaimer
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