- •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.
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.
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Hepatology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Evolution of NAFLD and its management.Nutr Clin Pract. 2020; 35: 72-84
- Epidemiology of non-alcoholic and alcoholic fatty liver diseases.Transl Gastroenterol Hepatol. 2020; 5 (16–16)
- Non-alcoholic fatty liver disease (NAFLD).2018 ([cited 2021 23 February]; Available from:)https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/#:∼:text=It's%20estimated%20up%20to%201,cirrhosis%2C%20if%20it%20gets%20worse
- Real-world data reveal a diagnostic gap in non-alcoholic fatty liver disease.BMC Med. 2018; 16: 130
- Risks and clinical predictors of cirrhosis and hepatocellular carcinoma diagnoses in adults with diagnosed NAFLD: real-world study of 18 million patients in four European cohorts.BMC Med. 2019; 17: 95
- Emerging awareness on the importance of skeletal muscle in liver diseases: time to dig deeper into mechanisms!.Clin Sci (Lond). 2019; 133: 465-481
- Association of sarcopenia and NAFLD: an overview.Clin Liver Dis. 2020; 16: 73-76
- Nonalcoholic fatty liver disease and sarcopenia: where do we stand?.Can J Gastroenterol Hepatol. 2020; 2020: 8859719
- Sarcopenia and risk of nonalcoholic fatty liver disease: a meta-analysis.Saudi J Gastroenterol. 2018; 24: 12-17
- Relationship between sarcopenia and nonalcoholic fatty liver disease: the Korean Sarcopenic Obesity Study.Hepatology. 2014; 59: 1772-1778
- Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a systematic review and meta-analysis.Hepatol Int. 2020; 14: 115-126
- Association of grip strength with non-alcoholic fatty liver disease: investigation of the roles of insulin resistance and inflammation as mediators.Eur J Clin Nutr. 2020; 74: 1401-1409
- Association between muscle strength and advanced fibrosis in non-alcoholic fatty liver disease: a Korean nationwide survey.J Cachexia Sarcopenia Muscle. 2020; 11: 1232-1241
- Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a 7-year longitudinal study.Hepatology. 2018; 68: 1755-1768
- Sarcopenia in nonalcoholic fatty liver disease: new challenges for clinical practice.Expert Rev Gastroenterol Hepatol. 2020; 14: 197-205
- What makes UK Biobank special?.Lancet (London, England). 2012; 379: 1173-1174
- UK Biobank: bank on it.Lancet (London, England). 2007; 369: 1980-1982
- UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.PLoS Med. 2015; 12e1001779
- The joint association of sarcopenia and frailty with incidence and mortality health outcomes: a prospective study.Clin Nutr. 2020;
- Estimation of skeletal muscle mass by bioelectrical impedance analysis.J Appl Physiol. 2000; 89 (Bethesda, Md : 1985): 465-471
- The association of grip strength with health outcomes does not differ if grip strength is used in absolute or relative terms: a prospective cohort study.Age Ageing. 2019; 48: 684-691
- Administrative coding in electronic health care record-based research of NAFLD: an Expert Panel Consensus statement.Hepatology. 2021; 74: 474-482
- Health and deprivation. Inequality and the North. vol. 10. Health Policy, New York1988
- A comprehensive definition for metabolic syndrome.Dis Model Mech. 2009; 2: 231-237
- The global epidemic of the metabolic syndrome.Curr Hypertens Rep. 2018; 20 (12-12)
- Metabolic syndrome: definitions and controversies.BMC Med. 2011; 9 (48-48)
- Physical activity in relation to body size and composition in women in UK Biobank.Ann Epidemiol. 2015; 25: 406-413.e406
- Nonlinear associations between cumulative dietary risk factors and cardiovascular diseases, cancer, and all-cause mortality: a prospective cohort study from UK Biobank.Mayo Clinic Proc. 2021; 96: 2418-2431
- The comparison of alternative smoothing methods for fitting non-linear exposure-response relationships with Cox models in a simulation study.Int J Biostat. 2009; 5 (Article 2)
- Population attributable fraction.BMJ. 2018; 360: k757
- Categorical versus continuous risk factors and the calculation of potential impact fractions.J Epidemiol Commun Health. 2010; 64: 209-212
- Association between patterns of alcohol consumption (beverage type, frequency and consumption with food) and risk of adverse health outcomes: a prospective cohort study.BMC Med. 2021; 19: 8
- Inflammation-associated interleukin-6/signal transducer and activator of transcription 3 activation ameliorates alcoholic and nonalcoholic fatty liver diseases in interleukin-10-deficient mice.Hepatology. 2011; 54: 846-856
- A PGC1-α-dependent myokine that drives brown-fat-like development of white fat and thermogenesis.Nature. 2012; 481: 463-468
- Review: the role of insulin resistance in nonalcoholic fatty liver disease.J Clin Endocrinol Metab. 2006; 91: 4753-4761
- Motivators and barriers for physical activity in the oldest old: a systematic review.Ageing Res Rev. 2011; 10: 464-474
- Age-related decrease in skeletal muscle mass is an independent risk factor for incident nonalcoholic fatty liver disease: a 10-year retrospective cohort study.Gut Liver. 2019; 13: 67-76
- Sarcopenia in patients with advanced liver disease.Curr Protein Pept Sci. 2018; 19: 681-691
- Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria.Hepatol Res. 2016; 46: 951-963
- Nonalcoholic fatty liver disease and sarcopenia in a Western population (NHANES III): the importance of sarcopenia definition.Clin Nutr. 2019; 38: 422-428
- Epidemiology of myosteatosis.Curr Opin Clin Nutr Metab Care. 2010; 13: 260-264
- Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population.Am J Epidemiol. 2017; 186: 1026-1034
- Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis.BMJ. 2020; 368: m131
- 5 year mortality predictors in 498,103 UK Biobank participants: a prospective population-based study.Lancet. 2015; 386: 533-540
- Grip strength and walking pace and cardiovascular disease risk prediction in 406,834 UK Biobank participants.Mayo Clinic Proc. 2020; 95: 879-888
- Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: a systematic review.J Hepatol. 2017; 66: 142-152
Published online: January 23, 2022
Accepted: January 4, 2022
Received in revised form: December 15, 2021
Received: April 7, 2021
Author names in bold designate shared co-first authorship
© 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.