Effects of GLP-1 Receptor Agonists on Muscle Mass, Strength, and Quality in MASLD: A Systematic Review

GLP-1 receptor agonists (GLP-1RAs) promote significant weight loss, but their impact on muscle mass, strength, and quality in metabolic dysfunction-associated steatotic liver disease (MASLD), a condition prone to muscle impairment, remains uncertain.

We conducted a systematic review of MEDLINE/PubMed, Embase, and the Cochrane Library up to 2 December 2025. Interventional and observational studies assessing GLP-1RA therapy and muscle-related outcomes in adults with MASLD were included. Muscle mass was assessed by computed tomography or magnetic resonance imaging, dual-energy X-ray absorptiometry, or bioelectrical impedance analysis; lean mass and fat-free mass were considered proxies. Muscle strength was evaluated using handgrip strength (HGS) or sit-to-stand (STS) tests. Muscle quality was assessed by imaging-based quantification of intramuscular fat infiltration (myosteatosis) or functionally based on performance relative to muscle mass. Results were synthesised narratively.

Twelve studies were included (n = 810). Eleven assessed muscle mass (n = 785) across different GLP-1RA regimens and treatment durations (12-52 weeks). Findings suggested relative preservation of muscle mass, with modest reductions generally proportional to overall weight loss. Muscle strength was evaluated in three studies (n = 477), with no evidence of deterioration in HGS or STS performance despite meaningful weight loss. Muscle quality was assessed in four studies (n = 139) using imaging or functional metrics, with results suggesting preserved or improved muscle quality. Evidence was limited by small sample sizes and heterogeneous assessment methods.

Current evidence suggests that GLP-1RA therapy is not associated with clinically meaningful loss of muscle mass or strength in adults with MASLD, with early data indicating possible improvements in muscle quality.