Background & Aims
We explored whether sarcopenia is associated with the histological severity of non-alcoholic
fatty liver disease (NAFLD), especially non-alcoholic steatohepatitis (NASH) and significant
fibrosis.
Methods
In a biopsy-proven NAFLD cohort, the appendicular skeletal muscle mass (ASM) was measured.
Sarcopenia was defined as a ASM/body weight (ASM%) value beyond two standard deviations
below the mean for healthy young adults.
Results
Among the entire set of 309 subjects, the prevalence of sarcopenia in subjects without
NAFLD, with non-alcoholic fatty liver (NAFL), and with NASH were 8.7%, 17.9%, and
35.0%, respectively (p <0.001). ASM% was inversely correlated with the severity of fibrosis (p <0.001), and the prevalence of significant fibrosis (⩾F2) was higher in subjects with
sarcopenia than in those without (45.7% vs. 24.7%; p <0.001). A crude analysis revealed that sarcopenia was associated with NAFLD (odds
ratio [OR], 3.82; 95% confidence interval [CI], 1.58–9.25), which became insignificant
after adjustment for body mass index (BMI), diabetes, and hypertension. Among NAFLD
subjects, subjects with sarcopenia were more likely to have NASH than those without
sarcopenia through a multivariate analysis adjusted for age, gender, BMI, hypertension,
diabetes, and smoking status (OR, 2.28; 95% CI, 1.21–4.30), and this finding was obtained
even after adjustment for insulin resistance (OR, 2.30; 95% CI, 1.08–4.93). Sarcopenia
was also associated with significant fibrosis independent of BMI and insulin resistance
(OR, 2.05; 95% CI, 1.01–4.16).
Conclusions
In this large biopsy-proven NAFLD cohort, sarcopenia was significantly associated
with NASH and significant fibrosis.
Lay summary
Low muscle mass was found to be associated with histological severity in non-alcoholic
fatty liver disease, and sarcopenia was significantly associated with non-alcoholic
steatohepatitis and significant fibrosis, independent of obesity, inflammation, and
insulin resistance.
Clinical trial number: NCT 02206841.
Graphical abstract

Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 03, 2016
Accepted:
August 26,
2016
Received in revised form:
August 18,
2016
Received:
May 12,
2016
See Editorial, pages 8–10Identification
Copyright
© 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.