Diabetes as a Risk Factor for Sarcopenia in Patients with MASH-Related Cirrhosis

<b>Objectives:</b> 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. <b>Methods:</b> 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 ≥1 metabolic risk factors. Mortality, liver-related events (LREs; ascites, variceal bleeding, encephalopathy, and hepatocellular carcinoma), and sarcopenia were compared using Kaplan-Meier analysis, log-rank tests, and Fisher's exact test. Risk factors for sarcopenia were assessed using logistic regression. <b>Results:</b> Median survival was significantly shorter in DM-MASH patients compared to non-DM MASH patients (1523 vs. 2618 days; <i>p</i> < 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%; <i>p</i> < 0.05). In multivariate analysis, DM emerged as an independent predictor of sarcopenia in patients with MASH-related cirrhosis. <b>Conclusions:</b> 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.