{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:49:50Z","timestamp":1765212590777,"version":"3.46.0"},"reference-count":35,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japanese Ministry of Health, Labour and Welfare Sciences Research","award":["23HC2001"],"award-info":[{"award-number":["23HC2001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Metabolic dysfunction-associated steatohepatitis (MASH) is a leading cause of cirrhosis within the spectrum of metabolic dysfunction-associated steatotic liver disease (MASLD). However, the prognostic impact of diabetes mellitus (DM) in MASH-associated cirrhosis remains unclear. This study aimed to compare clinical outcomes between cirrhotic patients with and without DM. Methods: Patients with MASH-related cirrhosis were stratified into DM (DM-MASH) and non-DM (non-DM MASH) groups. The diagnosis of MASH was based on histological evidence of steatohepatitis with underlying metabolic dysfunction. The non-DM group included both obese individuals and lean\/normal-weight individuals with \u22651 metabolic risk factors. Mortality, liver-related events (LREs; ascites, variceal bleeding, encephalopathy, and hepatocellular carcinoma), and sarcopenia were compared using Kaplan\u2013Meier analysis, log-rank tests, and Fisher\u2019s exact test. Risk factors for sarcopenia were assessed using logistic regression. Results: Median survival was significantly shorter in DM-MASH patients compared to non-DM MASH patients (1523 vs. 2618 days; p &lt; 0.05). The incidence of LREs during follow-up was also higher in the DM-MASH group. The prevalence of sarcopenia was significantly greater among DM-MASH patients (36.1% vs. 19.7%; p &lt; 0.05). In multivariate analysis, DM emerged as an independent predictor of sarcopenia in patients with MASH-related cirrhosis. Conclusions: DM is associated with worse outcomes in MASH-driven cirrhosis, including increased sarcopenia and reduced survival. DM may serve as a prognostic marker for identifying high-risk patients with MASH-associated cirrhosis.<\/jats:p>","DOI":"10.3390\/jcm14248691","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:41:41Z","timestamp":1765212101000},"page":"8691","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetes as a Risk Factor for Sarcopenia in Patients with MASH-Related Cirrhosis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3049-3443","authenticated-orcid":false,"given":"Shinya","family":"Sato","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Takaya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3158-5318","authenticated-orcid":false,"given":"Tadashi","family":"Namisaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9174-2477","authenticated-orcid":false,"given":"Jun-ichi","family":"Hanatani","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5794-1512","authenticated-orcid":false,"given":"Koh","family":"Kitagawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6295-3283","authenticated-orcid":false,"given":"Norihisa","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosuke","family":"Kaji","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Yoshiji","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Nara Medical University, Kashihara 634-8521, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/S0140-6736(21)01374-X","article-title":"Liver cirrhosis","volume":"398","author":"Gines","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1002\/hep.23478","article-title":"Now there are many (stages) where before there was one: In search of a pathophysiological classification of cirrhosis","volume":"51","author":"Friedman","year":"2010","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/j.cgh.2022.06.032","article-title":"Hepatocellular carcinoma incidence in alcohol-associated cirrhosis: Systematic review and meta-analysis","volume":"21","author":"Huang","year":"2023","journal-title":"Clin. 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