{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:24:37Z","timestamp":1787574277800,"version":"build-2736575974"},"reference-count":46,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>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 &gt; 4.4). Poor physical performance was linked to lower dehydroepiandrosterone sulfate (DHEAS) levels using both LFI (OR: 0.98, 95% C.I.: 0.96\u20130.99, p = 0.01) and SPPB (OR: 1.14, 95% C.I.: 1.003\u20131.22, p = 0.026). Frailty assessed by LFI was associated with increased liver stiffness (OR: 1.24, 95% C.I.: 1.047\u20131.482, 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.<\/jats:p>","DOI":"10.3390\/ijms27167431","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:10:20Z","timestamp":1787213420000},"page":"7431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sarcopenia and Frailty in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): The Impact of Steroid Hormones"],"prefix":"10.3390","volume":"27","author":[{"given":"Triada","family":"Bali","sequence":"first","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, 400 Parnassus Avenue, Floor 7, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niki G.","family":"Mourelatou","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8240-6865","authenticated-orcid":false,"given":"Aristi","family":"Saridaki","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0045-0461","authenticated-orcid":false,"given":"Sofia","family":"Tsitsou","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3306-050X","authenticated-orcid":false,"given":"Magdalini","family":"Adamantou","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7254-4617","authenticated-orcid":false,"given":"Aikaterini","family":"Kamiliou","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Chologitas","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita","family":"Sarri","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Pavlopoulou","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7162-3323","authenticated-orcid":false,"given":"Evangelos","family":"Liberopoulos","sequence":"additional","affiliation":[{"name":"First Department of Propaedeutic and Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0906-3617","authenticated-orcid":false,"given":"Anna","family":"Angelousi","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3645-582X","authenticated-orcid":false,"given":"Evangelos","family":"Cholongitas","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, Agiou Thoma 17, 11526 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.3350\/cmh.2024.0431","article-title":"Epidemiology of metabolic dysfunction-associated steatotic liver disease","volume":"31","author":"Younossi","year":"2025","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E93","DOI":"10.1097\/HEP.0000000000000696","article-title":"Reply: A multi-society Delphi consensus statement on new fatty liver disease nomenclature","volume":"79","author":"Lazarus","year":"2023","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"NAFLD: A multisystem disease","volume":"62","author":"Byrne","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.ecl.2023.02.004","article-title":"Metabolic-Associated Fatty Liver Disease and Sarcopenia","volume":"52","author":"Bali","year":"2023","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"91100","DOI":"10.4291\/wjgp.v15.i1.91100","article-title":"Prevalence and outcome of sarcopenia in non-alcoholic fatty liver disease","volume":"15","author":"Giri","year":"2024","journal-title":"World J. Gastrointest. Pathophysiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3205","DOI":"10.1007\/s00261-021-03294-3","article-title":"Sarcopenia: Imaging assessment and clinical application","volume":"47","author":"Chianca","year":"2021","journal-title":"Abdom. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/S0140-6736(19)31786-6","article-title":"Frailty: Implications for clinical practice and public health","volume":"394","author":"Hoogendijk","year":"2019","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103187","DOI":"10.1016\/j.dsx.2025.103187","article-title":"The relationship between nonalcoholic fatty liver disease and frailty: A systematic review and meta-analysis","volume":"19","author":"Khanmohammadi","year":"2025","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Atabieke, F., Li, X.-J., Aierken, A., Li, J., Zhang, Y., Aizezi, Y., Gao, H.-L., and Zhang, Z.-Q. (2024). Association between frailty and hepatic fibrosis in NAFLD among middle-aged and older adults: Results from NHANES 2017\u20132020. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1330221"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100663","DOI":"10.1016\/j.jhepr.2022.100663","article-title":"Adverse muscle composition is a significant risk factor for all-cause mortality in NAFLD","volume":"5","author":"Linge","year":"2022","journal-title":"JHEP Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chrysavgis, L., Mourelatou, N.G., Koloutsou, M.-E., Rozani, S., and Cholongitas, E. (2025). The Influence of Glucagon-like Peptide-1 Receptor Agonists and Other Incretin Hormone Agonists on Body Composition. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms262412130"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"84","DOI":"10.15605\/jafes.039.01.04","article-title":"The Roles of Non-Pharmacologic and Emerging Pharmacologic Management of Non-alcoholic Fatty Liver Disease and Sarcopenia: A Narrative Review","volume":"39","author":"Rivera","year":"2024","journal-title":"J. ASEAN Fed. Endocr. Soc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"149","DOI":"10.37349\/emed.2020.00011","article-title":"Nonalcoholic fatty liver disease and portal hypertension","volume":"1","author":"Ryou","year":"2020","journal-title":"Explor. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tarantino, G., Citro, V., and Capone, D. (2019). Nonalcoholic Fatty Liver Disease: A Challenge from Mechanisms to Therapy. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010015"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1186\/1479-5876-9-136","article-title":"Liver-spleen axis, insulin-like growth factor-(IGF)-I axis and fat mass in overweight\/obese females","volume":"9","author":"Savastano","year":"2011","journal-title":"J. Transl. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Biagetti, B., and Sim\u00f3, R. (2021). GH\/IGF-1 Abnormalities and Muscle Impairment: From Basic Research to Clinical Practice. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22010415"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Liu, C.-C., Huang, S.-P., Lee, Y.-C., Lee, C.-H., Huang, T.-Y., Geng, J.-H., Chang, C.-W., Lin, C.-Y., Juan, Y.-S., and Wu, W.-J. (2023). Metabolic dysfunction-associated fatty liver disease is an early predictor for testosterone deficiency in aging men without metabolic syndrome. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1252774"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/liv.15786","article-title":"Endogenous sex hormones and nonalcoholic fatty liver disease in US adults","volume":"44","author":"Kim","year":"2023","journal-title":"Liver Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e70384","DOI":"10.1111\/liv.70384","article-title":"Association of Hormonal Status with Sarcopenia, Frailty and Outcome in Patients with Decompensated Cirrhosis","volume":"45","author":"Adamantou","year":"2025","journal-title":"Liver Int."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Altajar, S., Wang, N., Rosenthaler, M.P., Murabito, J.M., and Long, M.T. (2023). NAFLD Associates with Sarcopenia Defined by Muscle Mass and Slow Walking Speed: A Cross-Sectional Analysis from the Framingham Heart Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12247523"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Liang, Y., Ye, X., Pan, M., Chen, Y., Yuan, Y., and Luo, L. (2025). Impact of steatotic liver disease subtypes, sarcopenia, and fibrosis on all-cause and cause-specific mortality: A 15.7-year cohort study. BMC Gastroenterol., 25.","DOI":"10.1186\/s12876-025-03661-0"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e000861","DOI":"10.1136\/bmjgast-2021-000861","article-title":"Prevalence of frailty in patients with non-cirrhotic non-alcoholic fatty liver disease","volume":"9","author":"Naimimohasses","year":"2022","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101544","DOI":"10.1016\/j.aohep.2024.101544","article-title":"Relationship between sarcopenia and metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and meta-analysis","volume":"29","author":"Malik","year":"2024","journal-title":"Ann. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1002\/hep.32049","article-title":"Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Lai","year":"2021","journal-title":"Hepatology"},{"key":"ref_26","first-page":"101947","article-title":"Sarcopenia Is a Key Determinant Marker of Lean Masld: A Comparative Analysis of Clinical Profile, Body Composition by Dexa, and Muscle Strength in Lean, Overweight, and Obese Masld Patients","volume":"30","author":"Duarte","year":"2025","journal-title":"Ann. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2596","DOI":"10.1038\/s41598-025-87176-4","article-title":"Relationship Between Body Mass Index and Low Skeletal Muscle Mass in Adults Based on NHANES 2011\u20132018","volume":"15","author":"Xie","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tang, W., Yu, J., Yang, K., Jia, J., Mao, X., and Song, F. (2025). Association between sarcopenia and components of metabolic syndrome among Chinese older adults: A population-based longitudinal study using CHARLS. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-24090-4"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1056\/NEJMra2301292","article-title":"Frailty in Older Adults","volume":"391","author":"Kim","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"615","DOI":"10.5604\/01.3001.0012.0930","article-title":"Association between Low Testosterone Levels and Sarcopenia in Cirrhosis: A Cross-sectional Study","volume":"17","author":"Low","year":"2018","journal-title":"Ann. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.cgh.2019.11.053","article-title":"Low Testosterone Is Associated With Nonalcoholic Steatohepatitis and Fibrosis Severity in Men","volume":"19","author":"Sarkar","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"104846","DOI":"10.1016\/j.archger.2022.104846","article-title":"Serum levels of dehydroepiandrosterone sulfate are associated with a lower risk of mobility-subtype frailty in older Japanese community-dwellers","volume":"105","author":"Zhang","year":"2022","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1093\/ageing\/afp015","article-title":"The association between dehydroepiandosterone and frailty in older men and women","volume":"38","author":"Voznesensky","year":"2009","journal-title":"Age Ageing"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Fedotcheva, T.A., Uspenskaya, M.E., Ulchenko, D.N., and Shimanovsky, N.L. (2024). Dehydroepiandrosterone and Its Metabolite 5-Androstenediol: New Therapeutic Targets and Possibilities for Clinical Application. Pharmaceuticals, 17.","DOI":"10.3390\/ph17091186"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S0015-0282(02)02985-0","article-title":"Androgen production in women","volume":"77","author":"Burger","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1530\/eje.0.1510717","article-title":"A longitudinal study of dehydroepiandrosterone sulphate (DHEAS) change in older men and women: The Rancho Bernardo Study","volume":"151","author":"Tannenbaum","year":"2004","journal-title":"Eur. J. Endocrinol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/hep.32157","article-title":"Frailty is associated with increased risk of cirrhosis disease progression and death","volume":"75","author":"Wang","year":"2021","journal-title":"Hepatology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"128","DOI":"10.36011\/cpp.2024.6.e13","article-title":"Use of dual-energy x-ray absorptiometry for body composition in chronic disease management","volume":"6","author":"Kim","year":"2024","journal-title":"Cardiovasc. Prev. Pharmacother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3666","DOI":"10.1210\/jcem.84.10.6079","article-title":"A Critical Evaluation of Simple Methods for the Estimation of Free Testosterone in Serum","volume":"84","author":"Vermeulen","year":"1999","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and \u03b2-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"101547","DOI":"10.1016\/j.eclinm.2022.101547","article-title":"Accuracy of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) for assessing steatosis and fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis","volume":"51","author":"Cao","year":"2022","journal-title":"eClinicalMedicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"99183","DOI":"10.4254\/wjh.v17.i1.99183","article-title":"Do Child\u2013Turcotte\u2013Pugh and nutritional assessments predict survival in cirrhosis: A longitudinal study","volume":"17","author":"Carteri","year":"2025","journal-title":"World J. Hepatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A Short Physical Performance Battery Assessing Lower Extremity Function: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J. Gerontol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"489","DOI":"10.7861\/clinmed.2020-0089","article-title":"Sarcopenia in cirrhosis: A practical overview","volume":"20","author":"Dhaliwal","year":"2020","journal-title":"Clin. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve","volume":"143","author":"Hanley","year":"1982","journal-title":"Radiology"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/16\/7431\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:41Z","timestamp":1787572061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/16\/7431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":46,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ijms27167431"],"URL":"https:\/\/doi.org\/10.3390\/ijms27167431","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}