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

• Published in: Journal of hepatology Vol. 66; no. 1; pp. 123 - 131
• Main Authors: Koo, Bo Kyung, Kim, Donghee, Joo, Sae Kyung, Kim, Jung Ho, Chang, Mee Soo, Kim, Byeong Gwan, Lee, Kook Lae, Kim, Won
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2017; Elsevier Science Ltd
• Subjects: Adult; Appendicular skeletal muscle mass; Biopsy; Biopsy - methods; Body Mass Index; Body weight; Diabetes; Diabetes mellitus; Disease Progression; Fatty liver; Female; Fibrosis; Gastroenterology and Hepatology; Hepatic steatosis; Humans; Hypertension; Insulin; Insulin resistance; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - etiology; Liver diseases; Male; Middle Aged; Multivariate analysis; Muscle, Skeletal - pathology; Non-alcoholic fatty liver disease; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - epidemiology; Non-alcoholic steatohepatitis; Prevalence; Republic of Korea - epidemiology; Risk Factors; Sarcopenia; Sarcopenia - diagnosis; Sarcopenia - epidemiology; Severity of Illness Index; Skeletal muscle; Smoking; Statistics as Topic; Young adults; Sarcopenia; Appendicular skeletal muscle mass; Body weight; Fibrosis; Insulin resistance; Hepatic steatosis; Diabetes; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis
• ISSN: 0168-8278; 1600-0641; 1600-0641
• DOI: 10.1016/j.jhep.2016.08.019

[Display omitted] 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. 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. 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). In this large biopsy-proven NAFLD cohort, sarcopenia was significantly associated with NASH and significant fibrosis. 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.