Background/Obejctives: Sarcopenic obesity (SO) has gained growing attention in metabolic dysfunction-associated steatotic liver disease (MASLD), yet data in Caucasian populations remain limited. The aim of this study was to assess the prevalence of SO using different definitions and to explore its relationship with steroid androgens, physical performance and frailty in MASLD individuals. Methods: Two hundred Caucasian patients with MASLD and available dual-energy X-ray absorptiometry (DEXA) data were evaluated. Clinical, biochemical, hormonal and elastography data were recorded, while physical performance was assessed using the Short Physical Performance Battery (SPPB) and Liver Frailty Index (LFI). Results: SO prevalence ranged from 34.5% to 76.5% depending on the definition applied (AIMSO score, body mass index, and body fat percentage-based criteria). Across definitions, SO individuals showed greater hepatic steatosis, more metabolic comorbidities and demonstrated poorer physical performance. Lower dehydroepiandrosterone sulfate (DHEAS) levels were independently associated with SO when the definition is based on total body fat percentage, and waist circumference (WC) was consistently linked to SO across all definitions. Separate analysis based on gender, confirmed that DHEAS was independently associated with SO in men, while WC represented an independent factor associated with SO in both genders. Conclusions: In conclusion, SO is common among Caucasian MASLD patients and is accompanied by metabolic, hepatic, hormonal, and functional alterations. These findings may help recognize patients at risk of SO and support more focused assessment and monitoring in clinical practice.

Background and objectives: Non-alcoholic fatty liver disease (NAFLD) is spreading at alarming rates, representing a serious public health problem, and it is the most common cause of chronic liver disease. This study aims to evaluate the effects of time-restricted feeding (TRF) along with a hypocaloric Mediterranean Diet (MD) on body weight and biochemical indices. Methods: This 12-week, open-label, randomized controlled trial [NCT05866744] consists of three interventional groups following a personalized diet (1500-2100 kcal/day): control group (MD without time restriction), early 14:10 TRF, and delayed 14:10 TRF. Anthropometric measurements and biochemical analyses are carried out at baseline and 12 weeks. Results: We recruited sixty NAFLD patients with a mean body mass index (BMI) of 31.8 ± 0.8 kg/m² and a mean age of 51.05 ± 2.74 years, out of whom twenty-one (10 males, 47.6%) have completed the ongoing trial (control n = 7, early TRF n = 6, delayed TRF n = 8). There was no difference in body weight between the groups at 12 weeks, but each group lost significant body weight compared to baseline (control: 6.3%, p = 0.015; early and delayed TRF: 8%, p = 0.004, and p = 0.001, respectively). The three groups differed in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels at 12 weeks. Significant decreases in BMI, waist circumference, hip circumference, fat mass, and systolic and diastolic blood pressure were observed in all groups. Additionally, in the control group, there was a decrease in fasting insulin, homeostatic model assessment for insulin resistance (HOMA-IR), alanine aminotransferase, and controlled attenuation parameter derived from elastography; while in the early TRF group, there was a tendency for lower glycated hemoglobin A1c. Finally, in the delayed TRF group, fasting glucose, gamma-glutamyl-transferase, and alkaline phosphatase were improved compared to baseline. There was no difference in pleasure rate between the three interventions at baseline or 12 weeks. Discussion: These preliminary data show that 14:10 TRF led to clinically significant weight loss (>5%), mainly via fat mass loss, and to an improved lipid profile, regardless of the time restrictions placed on food intake. Consequently, TRF could be an alternative weight loss strategy for individuals with NAFLD.

Sarcopenic obesity (SO) has gained growing attention in metabolic dysfunction-associated steatotic liver disease (MASLD), yet data in Caucasian populations remain limited. The aim of the study was to assess the prevalence of SO using different definitions and to explore its relationship with steroid androgens, physical performance and frailty in MASLD individuals. Two hundred Caucasian patients with MASLD and available dual-energy X-ray absorptiometry (DEXA) data were evaluated. Clinical, biochemical, hormonal and elastography data were recorded, while physical performance was assessed using the Short Physical Performance Battery (SPPB) and Liver Frailty Index (LFI). SO prevalence ranged from 34.5% to 76.5% based on different SO definitions. SO individuals showed greater hepatic steatosis, more metabolic comorbidities and demonstrated poorer physical performance. Lower dehydroepiandrosterone sulfate (DHEAS) levels were independently associated with SO when definition is based on total body fat percentage, and waist circumference (WC) was consistently linked to SO across all definitions. Separate analysis based on gender, confirmed DHEAS being independently associated with SO in men, while WC represented an independent SO predictor in both genders. In conclusion, SO is common among Caucasian MASLD patients and is accompanied by metabolic, hepatic, hormonal, and functional alterations, highlighting the need for better identification in clinical practice.

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.

Background/Objectives: Regional adipose tissue has been studied as a prognostic factor in various extra-hepatic diseases, but data in the setting of cirrhosis is scarce. Our aim was to evaluate the association of regional adipose tissue indices with the severity of liver disease and its impact on the outcome of patients with cirrhosis. Methods: Three hundred and thirty-seven patients with cirrhosis were prospectively enrolled in the study. Clinical and laboratory data were recorded, and MELD-Na and Child-Turcotte-Pugh scores were calculated. Physical performance was evaluated with handgrip strength, the Short Physical Performance Battery test, and the Liver Frailty Index. Dual-energy X-ray absorptiometry was used for the evaluation of total and regional lean and fat mass. Results: A low trunk fat percentage was found to be independently associated with a MELD-Na score ≥ 15 (Odds Ratio: 0.92, p = 0.007). MELD-Na score and trunk fat percentage were the only factors independently associated with mortality [Hazard Ratio (HR): 1.078, p = 0.02 and HR: 0.95, p = 0.03, respectively], while a separate analysis based on gender confirmed this finding only in men. In the total cohort, patients with a trunk fat percentage < 27.5% had worse outcomes (log-rank 11.4; p < 0.001). Conclusions: This study marks the first effort to examine the association of indices related to regional adipose tissue distribution with the severity of liver disease and outcome. Trunk fat percentage was the only body composition parameter independently associated with advanced liver disease and prognosis in the total cohort specifically in men, but not in women. Further studies are needed to validate the predictive role of adipose tissue in patients with cirrhosis.