Highlights
- •This is the first European cohort study exploring both grip strength and muscle mass associations with NAFLD.
- •Lower muscle mass and grip strength were associated with a higher risk of incident NAFLD.
- •One lower tertile of grip strength and muscle mass accounted for 17.7% and 33.1% of diagnosed incident cases, respectively.
Background & Aims
Cross-sectional studies have reported that lower muscle mass and strength are risk
factors for non-alcoholic fatty liver disease (NAFLD). However, the evidence from
prospective studies is limited. This study examined both the strength and pattern
of the associations between these 2 physical capability markers and severe NAFLD using
data from the UK Biobank study.
Methods
A total of 333,295 participants were included in this prospective study. Grip strength
was measured using a Jamar J00105 hydraulic hand dynamometer, and the Janssen equation
was used to estimate skeletal muscle mass by bioelectrical impedance. Muscle mass
was adjusted for body weight and all exposures were sex-standardised. Associations
of muscle mass and strength with severe NAFLD (defined as hospital admission or death)
were first investigated by tertile of each exposure using Cox proportional hazard
models. Non-linear associations were investigated using penalised cubic splines fitted
in the Cox proportional hazard models.
Results
After a median follow-up of 10 years (IQR 9.3 to 10.7 years), 3,311 individuals had
severe NAFLD (3,277 hospitalisations and 34 deaths). Compared with the lowest tertile
of muscle mass, the risk of severe NAFLD was lower in the middle (hazard ratio 0.76;
95% CI 0.70–0.83) and the highest tertile (hazard ratio 0.46; 95% CI 0.40–0.52). Tertiles
of grip strength showed a similar pattern. Non-linearity was only identified for muscle
mass (p <0.001). Being on the lower tertile of grip strength and muscle mass accounted for
17.7% and 33.1% of severe NAFLD cases, respectively.
Conclusions
Lower muscle mass and grip strength were associated with higher risk of developing
severe NAFLD. Interventions to improve physical capability may be protective, but
this needs to be investigated in appropriately designed trials.
Lay summary
Lower muscle mass – both quantity and quality – were associated with a higher risk
of severe non-alcoholic fatty liver disease. Therefore, improving muscle mass might
be a protective factor against this increasing public health problem.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: January 23, 2022
Accepted:
January 4,
2022
Received in revised form:
December 15,
2021
Received:
April 7,
2021
Footnotes
Author names in bold designate shared co-first authorship
Identification
Copyright
© 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
