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Sarcopenia is the progressive loss of skeletal muscle mass and functionality that is typically associated with older age. Recent literature has noted a high prevalence of sarcopenia in patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). This review seeks to compile the current understanding of the pathophysiology, diagnosis, outcomes, and management of sarcopenia in the setting of NAFLD and NASH. Patients with advanced fibrosis from NASH and NASH-related cirrhosis have been found to have significantly higher risks of developing sarcopenia. Recent evidence suggests that sarcopenia does not adversely affect liver transplant waitlist survival in patients with NASH cirrhosis. One-year post-liver transplant survival was also found to not differ significantly in individuals with NASH cirrhosis and pretransplant sarcopenia when compared to those without sarcopenia. While the association between the two pathologies has been well-established, additional investigation is necessary to elucidate the outcomes and novel treatment options for patients with sarcopenia and NASH.

Sarcopenia, defined as the loss of muscle strength, mass, and functionality, confers a poor prognosis in the setting of cirrhosis. Given its clinical significance, a better understanding of the underlying mechanisms leading to cirrhosis, sarcopenia, and their co-occurrence may improve these patients’ outcomes. Non-alcoholic steatohepatitis (NASH) shares many of the same etiologies as sarcopenia, including insulin resistance, chronic inflammation, and ectopic adipocyte deposition, which are hallmarks of metabolic syndrome (MS). NASH thus serves as a prime candidate for further exploration into the underlying pathophysiology and relationship between these three conditions. In this review, we discuss the natural history of NASH and sarcopenia, explore the interplay between these conditions in the scope of MS, and seek to better define how an assessment of muscle mass, strength, and functionality in this population is key to improved diagnosis and management of patients with sarcopenia and NASH.