Does the benefit of optimal MASH treatment depend on a reduction in myosteatosis?

The muscle-liver axis, well known in cirrhosis, is also important in the multisystem disease known as metabolic dysfunction-associated steatohepatitis (MASH). The convincing results obtained with a triple peroxisome proliferator-activated receptor (PPAR) agonist in this setting confirm this hypothesis, demonstrating a beneficial effect not only on the severity of MASH in terms of steatosis, inflammation and fibrosis, but also in terms of hepatic and muscle insulin sensitivity. The pathophysiology of MASH and mechanism of action of triple PPAR agonist suggest that this may be related to improved lipid management in skeletal muscles and highlights the importance of studying the muscle-adipose tissue-liver axis in the management of MASH.