<p>Sarcopenia Is an Independent Risk Factor for NAFLD in COPD: A Nationwide Survey (KNHANES 2008–2011)</p>

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and is independently associated with cardiometabolic comorbidities and systemic inflammation. Although several factors are associated with NAFLD, the influence of sarcopenia on NAFLD has not been fully determined in patients with COPD. We explored whether sarcopenia is associated with NAFLD in a COPD population. Methods: Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analyzed. The subjects were defined as having NAFLD when they had a hepatic steatosis index (HSI) score >36, which is a previously validated NAFLD prediction score. Sarcopenia_BMI (=total appendicular skeletal muscle mass [kg]/body mass index [kg/m 2 ]), sarcopenia_BW (=total appendicular skeletal muscle mass [kg]/body weight [kg] × 100), and sarcopenia_height (= total appendicular skeletal muscle mass (kg)/height 2 (m)) measured using dual-energy X-ray absorptiometry was used to diagnose sarcopenia. Results: NAFLD was identified in 124 (14.6%) of 850 COPD subjects using the HSI. Multivariable logistic analyses adjusted for age, sex, hypertension, diabetes mellitus (DM), forced vital capacity (FVC), and metabolic syndrome demonstrated that sarcopenia (sarcopenia_BMI, odds ratio [OR] = 1.95; 95% confidence interval [CI], 1.11-3.46, p = 0.022; sarcopenia_BW, OR = 2.25; 95% CI, 1.30-3.92, p = 0.004) was associated with NAFLD in patients with COPD. The proportion of sarcopenia_BMI was higher in patients with a high fibrotic burden from NAFLD (Q3, Q4) than in subjects with a low fibrotic burden from NALFD (Q1, Q2) (54.8% vs 24.2%, p = 0.024). The proportion of sarcopenia_BW was also higher in patients with a high fibrotic burden from NAFLD than in patients with a low fibrotic burden from NAFLD (51.6% vs 30.6%, p = 0.029). Conclusion:Sarcopenia was associated with an increased risk for NAFLD in patients with COPD, independent of age, sex, lung function, and metabolic factors. Sarcopenic COPD was also associated with a high fibrotic burden in NAFLD patients. Pulmonologists should be aware of possible liver comorbidities in the sarcopenic COPD phenotype.

Association between Sarcopenic Obesity and Nonalcoholic Fatty Liver Disease and Fibrosis detected by Fibroscan

“…Third, we were unable to adjust for inflammation and insulin resistance due to the unavailability of these factors in the current NHANES dataset. Although we tried to adjust known risk factors between two conditions, we also could not eliminate the possibility of unadjusted residual confounders in this study, such as the presence of chronic obstructive pulmonary disease that may affect the risk of two conditions [42]. Fourth, there are known tendencies of difference between liver stiffness or CAP measurement and probe types of transient elastography, and it is possible that the NAFLD and significant fibrosis may have been misclassified.…”

Lipid Metabolism Disorders in the Comorbid Course of Nonalcoholic Fatty Liver Disease and Chronic Obstructive Pulmonary Disease

“…Sarcopenia is an independent risk factor for NAFLD in COPD. It is interesting that sarcopenia in patients with COPD is associated with an increased risk of NAFLD and more severe fibrosis independent of lung function and metabolic characteristics [ 228 ]. Moreover, worsening histologic severity of NAFLD, especially at the fibrosis stage, is accompanied by decreased lung function [ 229 ].…”

Association of protein consumption and energy intake on sarcopenia in tuberculosis survivors

“…Several lung diseases such as TB, chronic obstructive pulmonary disease (COPD), and asthma can result in systemic inflammation, which can cause muscle loss and further exacerbate skeletal muscle detriment. 21 In addition, several studies showed that TB is also a risk factor for COPD and can increase the risk for restriction dysfunction due to residual lung damage. [37][38][39][40][41][42] These factors may contribute to sarcopenia in TB patients.…”

“…19 Definition of sarcopenia Sarcopenia was defined using the ASM in one of three ways: "sarcopenia_BMI = ASM/BMI," "sarcopenia_height = ASM/height 2 ," and "sarco-penia_weight = ASM/weight * 100," as mentioned in a previous study. 21 Sarcopenia was measured using the ASM/BMI, as recommended by the Foundation for the National Institutes of Health (FNIH) for men (<0.789) and women (<0.512); 22 using ASM/height 2 , as recommended by the Asian Working Group for Sarcopenia (AWGS) for men (<7.0) and women (<5.4); 23 and using ASM/weight × 100, which was calculated to be less than two standard deviations by the sex-specific mean for healthy young adults according to the 2008-2011 KNHANES data for men (<29.0) and women (<22.9). [24][25][26] Dietary assessments For dietary surveillance, well-trained dietitians conducted in-person interviews with participants, using 24-h recall methods and food frequency questionnaires (FFQs).…”