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Research Article| Volume 66, ISSUE 1, P123-131, January 2017

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Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis

  • Bo Kyung Koo
    Affiliations
    Division of Endocrinology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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  • Donghee Kim
    Correspondence
    Corresponding authors. Addresses: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Republic of Korea. Tel.: +82 2 870 2233; fax: +82 2 831 2826 (W. Kim), or Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94304, United States. Tel.: +1 650 497 9261; fax: +1 650 723 5488 (D. Kim).
    Affiliations
    Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, United States
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  • Sae Kyung Joo
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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  • Jung Ho Kim
    Affiliations
    Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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  • Mee Soo Chang
    Affiliations
    Department of Pathology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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  • Byeong Gwan Kim
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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  • Kook Lae Lee
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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  • Won Kim
    Correspondence
    Corresponding authors. Addresses: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Republic of Korea. Tel.: +82 2 870 2233; fax: +82 2 831 2826 (W. Kim), or Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94304, United States. Tel.: +1 650 497 9261; fax: +1 650 723 5488 (D. Kim).
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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Published:September 03, 2016DOI:https://doi.org/10.1016/j.jhep.2016.08.019

      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

      Keywords

      Linked Article

      • The relationship between age and fat infiltration in liver and muscle
        Journal of HepatologyVol. 67Issue 4
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          We read with great interest the paper by Koo et al. in the January issue of the Journal of Hepatology.1
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      • Reply to: “The association between sarcopenia and non-alcoholic fatty liver disease”
        Journal of HepatologyVol. 66Issue 1
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          We appreciate the interest expressed in the letter written by Hu et al. They raised the question that vitamin D status, uric acid levels, or thyroid function might be the confounders in the association between sarcopenia and non-alcoholic steatohepatitis (NASH), which we have reported on previously [1]. We agree with Hu and colleagues that many epidemiologic studies have shown an association between the risk of non-alcoholic fatty liver disease (NAFLD) and vitamin D status [2], uric acid levels, or thyroid function [3].
        • Full-Text
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      • The association between sarcopenia and non-alcoholic fatty liver disease
        Journal of HepatologyVol. 66Issue 1
        • Preview
          We read with great interest the article by Koo et al. [1], who have investigated the association between sarcopenia and the histological severity of patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD). This prospective cohort study enrolled 309 subjects and found that patients with sarcopenia, after adjustment for age, gender, body mass index (BMI), hypertension, diabetes, and smoking status, was associated with non-alcoholic steatohepatitis (NASH) [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.21–4.03].    
        • Full-Text
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      • Does the liver accelerate ageing: Talking muscles and liver?
        Journal of HepatologyVol. 66Issue 1
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          Despite what the general media would like us to believe, we live in a time of unparalleled health. People are living longer; the increase in longevity has been driven by a decline in early life mortality as a result of improved hygiene and nutrition in the early 20th century, with the advent of new drugs delivering a decline in late life mortality in the 21st century [1]. As a consequence of our success in ageing, we are now facing a new problem, how to live well as well as longer.
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