{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:37:36Z","timestamp":1793144256271,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Minufiya University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Exp Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Sarcopenic visceral obesity (SVO) has emerged as a high-risk metabolic phenotype in metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to define the prevalence and metabolic implications of MRI-defined SVO in MASLD, evaluate its association with liver fibrosis, cardiovascular risk, and introduce a novel tier-based classification for risk stratification. In this cross-sectional study, 334 adults with MASLD underwent comprehensive phenotyping. Sarcopenia was assessed by bioelectrical impedance analysis, while visceral obesity was quantified via MRI-based visceral fat area (VFA\u2009\u2265\u2009100 cm\n                    <jats:sup>2<\/jats:sup>\n                    ). Liver fibrosis was evaluated using non-invasive indices and confirmed in a subset by magnetic resonance elastography (MRE). Participants were stratified into SVO and non-SVO groups, and further categorized into Red, Yellow, or Green tiers based on fibrosis stage and cardiovascular risk. SVO was present in 42.5% of MASLD patients, with higher prevalence among women and individuals with BMI\u2009\u2265\u200940. SVO was associated with significantly worse metabolic profiles (HOMA-IR: 6.2\u2009\u00b1\u20092.8,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), advanced fibrosis (FIB-4: 2.3\u2009\u00b1\u20091.4,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003), and higher cardiovascular risk (ASCVD\u2009\u2265\u20097.5%: 65%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). In multivariate analysis, SVO independently predicted advanced fibrosis (OR\u2009=\u20092.5,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). Importantly, a tier-based classification model identified a high-risk \u201cRed Tier\u201d group (100% F3\u2013F4 fibrosis, 100% diabetes). This is the first study in a Middle Eastern MASLD cohort to combine MRI-based adiposity assessment with validated sarcopenia criteria to define SVO and demonstrate its prognostic relevance. The introduction of a tiered risk framework integrating SVO, fibrosis, and ASCVD risk represents a novel approach to personalized MASLD care and support targeted decision-making.\n                  <\/jats:p>","DOI":"10.1007\/s10238-025-01865-y","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T04:53:07Z","timestamp":1761022387000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Sarcopenic visceral obesity in patients with metabolic dysfunction-associated steatotic liver disease (MASLD)"],"prefix":"10.1007","volume":"25","author":[{"given":"Maha","family":"Elsabaawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Ragab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Abd-Elrazek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Atef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madiha","family":"Naguib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"issue":"1","key":"1865_CR1","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.jhep.2022.12.001","volume":"78","author":"ME Rinella","year":"2023","unstructured":"Rinella ME, Lazarus JV, Ratziu V, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;78(1):196\u2013214. https:\/\/doi.org\/10.1016\/j.jhep.2022.12.001.","journal-title":"J Hepatol"},{"issue":"9","key":"1865_CR2","doi-asserted-by":"publisher","first-page":"2195","DOI":"10.1111\/ajt.17079","volume":"22","author":"NB Ha","year":"2022","unstructured":"Ha NB, Montano-Loza AJ, Carey EJ, et al. Sarcopenic visceral obesity is associated with increased post-liver transplant mortality in acutely ill patients with cirrhosis. Am J Transplant. 2022;22(9):2195\u2013202. https:\/\/doi.org\/10.1111\/ajt.17079.","journal-title":"Am J Transplant"},{"issue":"4","key":"1865_CR3","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1016\/j.clnu.2021.11.014","volume":"41","author":"LM Donini","year":"2022","unstructured":"Donini LM, Busetto L, Bischoff SC, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr. 2022;41(4):990\u20131000. https:\/\/doi.org\/10.1016\/j.clnu.2021.11.014.","journal-title":"Clin Nutr"},{"key":"1865_CR4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.metabol.2019.05.003","volume":"98","author":"SA Polyzos","year":"2019","unstructured":"Polyzos SA, Margioris AN. Sarcopenic obesity in fatty liver. Metabolism. 2019;98:1\u20135. https:\/\/doi.org\/10.1016\/j.metabol.2019.05.003.","journal-title":"Metabolism"},{"issue":"2","key":"1865_CR5","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1002\/hep.32507","volume":"77","author":"S Carias","year":"2023","unstructured":"Carias S, Castellanos AL, Vilchez V, et al. Sarcopenic visceral obesity predicts mortality in cirrhosis: a machine learning approach. Hepatology. 2023;77(2):649\u201365. https:\/\/doi.org\/10.1002\/hep.32507.","journal-title":"Hepatology"},{"issue":"25","key":"1865_CR6","doi-asserted-by":"publisher","first-page":"3823","DOI":"10.3748\/wjg.v27.i25.3823","volume":"27","author":"M El-Kassas","year":"2021","unstructured":"El-Kassas M, Ziade C, El-Sayed MH, et al. Nonalcoholic fatty liver disease in the Middle East and North Africa region. World J Gastroenterol. 2021;27(25):3823\u201343. https:\/\/doi.org\/10.3748\/wjg.v27.i25.3823.","journal-title":"World J Gastroenterol"},{"issue":"1","key":"1865_CR7","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1161\/CIRCULATIONAHA.106.675355","volume":"116","author":"CS Fox","year":"2007","unstructured":"Fox CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116(1):39\u201348. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.106.675355.","journal-title":"Circulation"},{"issue":"10","key":"1865_CR8","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1161\/CIRCULATIONAHA.111.067264","volume":"126","author":"JP Despr\u00e9s","year":"2012","unstructured":"Despr\u00e9s JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126(10):1301\u201313. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.111.067264.","journal-title":"Circulation"},{"issue":"2","key":"1865_CR9","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1038\/oby.2006.43","volume":"14","author":"JL Kuk","year":"2006","unstructured":"Kuk JL, Katzmarzyk PT, Nichaman MZ, Church TS, Blair SN, Ross R. Visceral fat is an independent predictor of all-cause mortality in men. Obesity. 2006;14(2):336\u201341. https:\/\/doi.org\/10.1038\/oby.2006.43.","journal-title":"Obesity"},{"key":"1865_CR10","unstructured":"-World Health Organization. Physical Status: The Use and Interpretation of Anthropometry: Report of a WHO Expert Committee. WHO Technical Report Series, No. 854. Geneva, Switzerland: World Health Organization; 1995."},{"issue":"6","key":"1865_CR11","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1002\/hep.21178","volume":"43","author":"RK Sterling","year":"2006","unstructured":"Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection. Hepatology. 2006;43(6):1317\u201325. https:\/\/doi.org\/10.1002\/hep.21178.","journal-title":"Hepatology"},{"issue":"1","key":"1865_CR12","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","volume":"48","author":"AJ Cruz- Jentoft","year":"2019","unstructured":"Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16\u201331. https:\/\/doi.org\/10.1093\/ageing\/afy169.","journal-title":"Age Ageing"},{"issue":"1","key":"1865_CR13","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1148\/radiology.211.1.r99ap15283","volume":"211","author":"T Yoshizumi","year":"1999","unstructured":"Yoshizumi T, Nakamura T, Yamane M, et al. Abdominal fat: standardized technique for measurement at CT. Radiology. 1999;211(1):283\u20136. https:\/\/doi.org\/10.1148\/radiology.211.1.r99ap15283.","journal-title":"Radiology"},{"issue":"6","key":"1865_CR14","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1097\/HCR.0000000000000746","volume":"42","author":"R Rikhi","year":"2022","unstructured":"Rikhi R, Shapiro MD. Assessment of atherosclerotic cardiovascular disease risk in primary prevention. J Cardiopulm Rehabil Prev. 2022;42(6):397\u2013403. https:\/\/doi.org\/10.1097\/HCR.0000000000000746.","journal-title":"J Cardiopulm Rehabil Prev"},{"issue":"8","key":"1865_CR15","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1038\/nrendo.2012.49","volume":"8","author":"BK Pedersen","year":"2012","unstructured":"Pedersen BK, Febbraio MA. Muscles, exercise and obesity: skeletal muscle as a secretory organ. Nat Rev Endocrinol. 2012;8(8):457\u201365. https:\/\/doi.org\/10.1038\/nrendo.2012.49.","journal-title":"Nat Rev Endocrinol"},{"issue":"2","key":"1865_CR16","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.cell.2009.12.052","volume":"140","author":"EJ Park","year":"2010","unstructured":"Park EJ, Lee JH, Yu GY, et al. Dietary and genetic obesity promote liver inflammation and tumorigenesis by enhancing IL-6 and TNF expression. Cell. 2010;140(2):197\u2013208. https:\/\/doi.org\/10.1016\/j.cell.2009.12.052.","journal-title":"Cell"},{"issue":"5","key":"1865_CR17","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1016\/j.cmet.2013.03.008","volume":"17","author":"T Tchkonia","year":"2013","unstructured":"Tchkonia T, Thomou T, Zhu Y, et al. Mechanisms and metabolic implications of regional differences among fat depots. Cell Metab. 2013;17(5):644\u201356. https:\/\/doi.org\/10.1016\/j.cmet.2013.03.008.","journal-title":"Cell Metab"},{"issue":"4","key":"1865_CR18","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/S2468-1253(20)30367-9","volume":"6","author":"DA Koutoukidis","year":"2021","unstructured":"Koutoukidis DA, Astbury NM, Tudor KE, et al. Association of weight loss interventions with changes in biomarkers of nonalcoholic fatty liver disease: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021;6(4):313\u201326. https:\/\/doi.org\/10.1016\/S2468-1253(20)30367-9.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"2","key":"1865_CR19","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/S2213-8587(24)00318-8","volume":"13","author":"N Stefan","year":"2025","unstructured":"Stefan N, Yki-J\u00e4rvinen H. Metabolic dysfunction-associated steatotic liver disease: heterogeneous pathomechanisms and effectiveness of metabolism-based treatment. Lancet Diabetes Endocrinol. 2025;13(2):134\u201348. https:\/\/doi.org\/10.1016\/S2213-8587(24)00318-8.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"8","key":"1865_CR20","doi-asserted-by":"publisher","DOI":"10.3390\/cells10081917","volume":"10","author":"S Mukherjee","year":"2021","unstructured":"Mukherjee S, et al. Familiarity breeds strategy. In silico untangling of the molecular complexity on course of autoimmune liver disease-to-hepatocellular carcinoma transition predicts novel transcriptional signatures. Cells. 2021;10(8):1917. https:\/\/doi.org\/10.3390\/cells10081917.","journal-title":"Cells"},{"issue":"S1","key":"1865_CR21","doi-asserted-by":"publisher","first-page":"S69","DOI":"10.1038\/s41379-018-0048-0","volume":"20","author":"ZD Goodman","year":"2007","unstructured":"Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. Mod Pathol. 2007;20(S1):S69\u201385. https:\/\/doi.org\/10.1038\/s41379-018-0048-0.","journal-title":"Mod Pathol"},{"issue":"2","key":"1865_CR22","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.jhep.2018.12.003","volume":"70","author":"C Lackner","year":"2019","unstructured":"Lackner C, Tiniakos D. Fibrosis and alcohol-related liver disease. J Hepatol. 2019;70(2):294\u2013304. https:\/\/doi.org\/10.1016\/j.jhep.2018.12.003.","journal-title":"J Hepatol"},{"issue":"5","key":"1865_CR23","doi-asserted-by":"publisher","first-page":"2202","DOI":"10.1016\/j.clnu.2018.09.019","volume":"38","author":"N Kamo","year":"2019","unstructured":"Kamo N, Kaido T, Hamaguchi Y, et al. Impact of sarcopenic obesity on outcomes in patients undergoing living donor liver transplantation. Clin Nutr. 2019;38(5):2202\u20139. https:\/\/doi.org\/10.1016\/j.clnu.2018.09.019.","journal-title":"Clin Nutr"},{"issue":"2","key":"1865_CR24","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1038\/s41575-022-00685-y","volume":"20","author":"ZM Younossi","year":"2023","unstructured":"Younossi ZM, Rinella ME, Loomba R, et al. From NAFLD to MAFLD: implications of a premature taxonomy change. Nat Rev Gastroenterol Hepatol. 2023;20(2):89\u2013106. https:\/\/doi.org\/10.1038\/s41575-022-00685-y.","journal-title":"Nat Rev Gastroenterol Hepatol"}],"container-title":["Clinical and Experimental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10238-025-01865-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10238-025-01865-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10238-025-01865-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:48:04Z","timestamp":1764917284000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10238-025-01865-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1865"],"URL":"https:\/\/doi.org\/10.1007\/s10238-025-01865-y","relation":{},"ISSN":["1591-9528"],"issn-type":[{"value":"1591-9528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"assertion":[{"value":"17 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the Institutional Review Board (IRB approval number: (0014014FWA00034015), and written informed consent was obtained from all participants prior to enrollment.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"316"}}