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• Low serum Mn can be a noninvasive marker predicting myosteatosis among cirrhosis. • Mn concentrations negatively correlated with intramuscular adipose tissue content. • Measuring temporal Mn is a surrogate to monitor muscular abnormalities progression. Emerging evidence expands on a close connection between trace elements and muscular abnormalities, mostly focusing on sarcopenia. We hypothesized an association between concentrations of serum trace elements and myosteatosis, given that myosteatosis has a more pronounced clinical implication relative to sarcopenia, but there is a paucity of data in patients with cirrhosis. Consecutive patients were hospitalized for cirrhosis-associated complications. Serum trace elements (zinc, copper, manganese [Mn], magnesium, calcium, and iron) were measured by inductively coupled plasma mass spectrometry. The presence of myosteatosis was defined according to computed tomography–demarcated intramuscular adipose tissue content. In total, the 295 patients with cirrhosis analyzed had a median age of 63 years and 53.6% were male. Among them, 42 patients presented with myosteatosis (14.2%) and concomitant higher Model for End-stage Liver Disease-Sodium and triglyceride concentrations and lower neutrophil counts and serum Mn concentrations (all P <.05). No differences were found regarding other 5 trace elements in patients with versus without myosteatosis. The median serum Mn concentrations were 1.16 µg/L, and this population was categorized into high-Mn and low-Mn groups. The proportion of myosteatosis was significantly lower in high-Mn group than that in low-Mn group (8.1% vs 20.4%, P <.001). Univariable binary logistic regression indicated that low Mn was associated with myosteatosis (odds ratio, 2.906; 95% confidence interval, 1.424–5.932; P =.003) in the context of cirrhosis. This result was validated according to multivariable analysis by adjusting for confounding factors. In conclusion, low serum Mn can be predictive of myosteatosis, a novel muscular abnormality representing more clinical relevance and close relation to inferior outcomes among cirrhosis. Our preliminary results unveiled low serum Mn can be a noninvasive marker predicting myosteatosis among hospitalized patients with cirrhosis. We observed that concentrations of serum Mn were negatively correlated with the values of intramuscular adipose tissue content, an indicator identifying myosteatosis. Collectively, these findings implicated that temporal serum Mn may be a surrogate to keeping muscular abnormality progression under observation from both preventive and interventive insights. Abbreviations: Ca, calcium; Cu, copper; Fe, iron; Mg, magnesium; Mn, manganese; Zn, zinc. [Display omitted] [ABSTRACT FROM AUTHOR]