Background & Aims
Although sarcopaenia is associated with obesity-related comorbidities, its influence
on non-alcoholic fatty liver disease (NAFLD) or steatohepatitis has not been fully
determined. We aimed to investigate the direct relationship between sarcopaenia and
NAFLD or steatohepatitis in the general population.
Methods
We conducted a cross-sectional study using nationally representative samples of 15,132
subjects from the Korea National Health and Nutrition Examination Surveys 2008–2011.
Subjects were defined as having NAFLD when they had higher scores from previously
validated NAFLD prediction models such as the hepatic steatosis index, comprehensive
NAFLD score and NAFLD liver fat score. BARD and FIB-4 scores were used to define advanced
fibrosis in subjects with NAFLD. The skeletal muscle index (SMI) [SMI(%) = total appendicular skeletal muscle mass (kg)/weight (kg) × 100] measured by dual-energy X-ray absorptiometry was used to diagnose sarcopaenia
with cut points of 32.2% for men and 25.5% for women.
Results
SMI was inversely correlated with all NAFLD predicting scores (Ps <0.001). After stratification, sarcopaenic subjects had an increased risk of NAFLD
regardless of obesity (odds ratios [ORs] = 1.55 to 3.02, depending on models; all Ps <0.001) or metabolic syndrome (ORs = 1.63 to 4.00, all Ps <0.001). Multiple logistic regression analysis also demonstrated this independent
association between sarcopaenia and NAFLD after adjusting for confounding factors
related to obesity or insulin resistance (ORs = 1.18 to 1.22, all Ps <0.001). Furthermore, among the NAFLD population, subjects with lower SMIs were likely
to have advanced fibrosis compared with non-sarcopaenic individuals (BARD and FIB-4:
ORs = 1.83 and 1.69, respectively; both Ps <0.001). Compared with non-exercised subjects, individuals who exercised regularly
had a lower risk of NAFLD (p <0.001), particularly among obese people with well-preserved muscle mass.
Conclusions
Sarcopaenia is associated with increased risks of NAFLD and advanced fibrosis, independent
of obesity or metabolic control.
Abbreviations:
NAFLD (Non-alcoholic fatty liver disease), NASH (Non-alcoholic steatohepatitis), KNHANES (Korea National Health and Nutrition Examination Survey), ASM (Appendicular skeletal muscle mass), SMI (Skeletal muscle mass index), SD (Standard deviation), BMI (Body mass index), HSI (Hepatic steatosis index), CNS (Comprehensive NAFLD score), LFS (NAFLD liver fat score), HOMA-IR (Homeostasis model assessment of insulin resistance), AST (Aspartate transaminase), ALT (Alanine transaminase), AOR (Adjusted odds ratio)Keywords
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Article info
Publication history
Published online: March 14, 2015
Accepted:
February 25,
2015
Received in revised form:
February 20,
2015
Received:
November 21,
2014
See Editorial, pages 309–311Identification
Copyright
© 2015 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
