JDDH Journal

Abstract

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a growing global health concern closely linked to obesity, insulin resistance, and metabolic syndrome. While body composition parameters and alcohol intake are known to influence disease progression, their specific associations with hepatic steatosis and fibrosis remain incompletely defined. Methods: We evaluated 174 male patients with MASLD. Hepatic steatosis and fibrosis were assessed via controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) using transient electrography. Skeletal muscle index (SMI) and visceral fat area (VFA) were determined through bioelectrical impedance analysis. Participants were stratified by alcohol consumption (<30 g/day vs. none). Multivariate logistic regression was used to identify independent predictors of severe steatosis and advanced fibrosis. Results: Severe steatosis was independently associated with light alcohol intake (OR 1.22, p=0.020), higher age-adjusted SMI z-score (OR 1.82, p=0.003), and triglyceride levels (OR 1.01, p=0.009). Age adjusted SMI z-score showed a positive correlation with CAP (R=0.328, p<0.001). For advanced fibrosis, SMI z-score (OR 1.84, p=0.013) and AST levels (OR 1.04, p<0.001) were risk factors, while light alcohol intake (OR 0.068, p=0.025) and platelet count (OR 0.99, p=0.016) were inversely associated. Notably, light drinkers exhibited higher CAP but lower LSM compared to non-drinkers. Conclusion: Age adjusted skeletal muscle mass is positively associated with both steatosis and fibrosis severity in male MASLD patients. Light alcohol consumption may paradoxically elevate hepatic fat while reducing fibrosis. Body composition and drinking habits are critical factors in MASLD risk stratification.