Nonalcoholic Fatty Liver Disease in The Rotterdam Study: About Muscle Mass, Sarcopenia, Fat Mass, and Fat Distribution

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease worldwide. Obesity is a major risk factor for NAFLD and recently, low skeletal muscle mass emerged as additional risk factor for NAFLD. However, the different contributions of body mass index (BMI) to the risk of NAFLD are not yet well‐known. We therefore studied body composition and muscle function with NAFLD in an elderly population‐based study. Participants of European descent underwent dual‐energy X‐ray absorptiometry (DXA) and hepatic ultrasonography. NAFLD was defined as liver steatosis in absence of secondary causes for steatosis. Skeletal muscle index (SMI) was defined as appendicular lean mass/height2 and (pre)sarcopenia was defined using the European Working Group on Sarcopenia in Older People (EWGSOP) consensus guidelines. All analyses were stratified by sex and BMI (cut point: 25 kg/m2) and adjusted for age, weight, height, homeostasis model assessment of insulin resistance (HOMA‐IR), triglycerides, and android‐fat‐to‐gynoid‐fat ratio (AGR). We included 4609 participants, of whom 1623 had NAFLD (n = 161 normal‐weight and n = 1462 overweight). Presarcopenia and sarcopenia prevalence was low (5.9% and 4.5%, respectively) and both were not associated with NAFLD. SMI was associated with less NAFLD in normal‐weight women (OR, 0.48; 95% CI, 0.29 to 0.80). A similar association for SMI and NAFLD was seen in normal‐weight men, but significance dissipated after adjustment for AGR (OR, 0.63; 95% CI, 0.39 to 1.02). Generally, fat mass was a better predictor for NAFLD than lean mass. In particular, android fat mass was associated with all NAFLD subgroups (OR from 1.77 in overweight men to 8.34 in normal‐weight women, p max = 0.001), whereas substitution of gynoid fat mass for other body components had a significant protective association with NAFLD in every subgroup, but normal‐weight men. Likewise, AGR was the best performing predictor for NAFLD prevalence (OR from 1.97 in normal‐weight men to 4.81 in normal‐weight women, p max < 0.001). In conclusion, both high fat mass and low SMI were associated with normal‐weight NAFLD. However, fat distribution (as assessed by AGR) could best predict NAFLD prevalence. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.

Relative fat mass at baseline and its early change may be a predictor of incident nonalcoholic fatty liver disease

“…However, recommending or performing liver biopsy in presumably healthy individuals could raise an ethical concern, considering that this study exclusively enrolled health checkup examinees. Second, the bioelectrical impedance analyzer used in this study was unable to determine the distribution (android or gynoid) of the fat mass, which is known to be related to metabolic abnormalities and NAFLD 19,33 . In addition, assessment of visceral adiposity, such as abdominal fat computed tomography, was unavailable.…”

“…Additionally, our results indicated that high baseline fat mass was a better predictor for incident NAFLD than low muscle mass in the normal-weight, overweight, and obese groups. From the Rotterdam study of a large population-based cohort, cross-sectional analysis showed that both high fat mass and low muscle mass were associated with NAFLD in normal-weight women (BMI < 25), whereas fat mass was a better predictor for NAFLD prevalence in both sexes 19 . Likewise, our results suggested that relative excess of fat mass predicted incident NAFLD better in all study populations except in participants with BMI < 18.5, whereas low muscle mass was only significant in the normal-weight subgroup.…”

“…Therefore, more robustness of fat mass compared with muscle mass in terms of NAFLD risk in the present study must be validated in other populations, including those in the West. Although there have been several Western studies on the relationship between body composition and NAFLD, which included advanced nonalcoholic steatohepatitis 29 , 30 , similar studies in a presumably healthy population are scarce, except for the Rotterdam study 19 . Despite its cross-sectional design, the results of the Rotterdam study at least underscore the relative importance of fat mass in NAFLD risk.…”

Sarcopenia Is Associated with the Presence of Nonalcoholic Fatty Liver Disease in Zhejiang Province, China: A Cross-Sectional Observational Study.

“…Recent clinical studies have already demonstrated a positive relationship between sarcopenia and the prevalence of NAFLD [6,11,19,20]. Hong et al rstly found the OR for NAFLD risk was 5.16 (95%CI 1.63-16.33) in the lowest quartile of SMI compared to the highest quartile [6].…”

Association between Different Animal Protein Sources and Liver Status in Obese Subjects with Non-Alcoholic Fatty Liver Disease: Fatty Liver in Obesity (FLiO) Study

“…Contrary to our expectations, subjects with higher processed meat consumption registered lower liver stiffness values, while previous studies indicated that processed meat consumption was associated with an increased risk of chronic liver disease [43]. This result might be explained since transient elastography is a technique to assess the presence of advanced fibrosis or cirrhosis [44] and according to several authors, the cut-off point in order to determine liver fibrosis ranges from 6.5 to 8 kPa [6,45,46,47]. Our study population presented lower liver stiffness values, suggesting that participants did not present hepatic fibrosis.…”