Sarcopenia in nonalcoholic fatty liver disease and all‐cause and cause‐specific mortality in the United States

Kim, Dong‐Hee; Wijarnpreecha, Karn; Sandhu, Keeryth K; Cholankeril, George; Ahmed, Aijaz

doi:10.1111/liv.14852

Cited by 52 publications

(51 citation statements)

References 40 publications

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“…The differences in the study population with respect to ethnicity and gender directly impact the body composition and thus limits the generalizability of the results. Most of the studies have been performed on Asian populations (10,14,17) and only a minority have been performed in Europe (159) or in the US (160)(161)(162). One study performed in the US has shown that the prevalence of sarcopenia was higher in females, in Hispanics and non-Hispanics whites (>40.0%) compared to non-Hispanic Black and non-Hispanic Asian (<10.0%) (161).…”

Section: Clinical Evidence Linking Nafld and Sarcopeniamentioning

confidence: 99%

“…Furthermore, increasing ASM-to-weight had a positive impact both on the risk of incident NAFLD and the resolution of existing NAFLD even after adjusting for metabolic confounders ( 164 ). Several longitudinal follow-up studies showed that sarcopenic patients with NAFLD had poor clinical outcomes and increased risk in overall (OR 1.28; 95% CI 1.06–1.5) and specific mortality, particularly cardiovascular, cancer, and diabetes related mortality ( 162 ). Another recent study analyzing the NHANES 1999–2004 dataset reported a 78.0% increased risk in all-cause mortality and a 320.0% increase in cardiac-specific mortality in patients with sarcopenia-related NAFLD ( 128 ).…”

Section: Clinical Evidence Linking Nafld and Sarcopeniamentioning

confidence: 99%

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Impact of Sarcopenia on the Severity of the Liver Damage in Patients With Non-alcoholic Fatty Liver Disease

et al. 2022

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An extensive body of the literature shows a strong interrelationship between the pathogenic pathways of non-alcoholic fatty liver disease (NAFLD) and sarcopenia through the muscle-liver-adipose tissue axis. NAFLD is one of the leading causes of chronic liver diseases (CLD) affecting more than one-quarter of the general population worldwide. The disease severity spectrum ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis, and its complications: end-stage chronic liver disease and hepatocellular carcinoma. Sarcopenia, defined as a progressive loss of the skeletal muscle mass, reduces physical performances, is associated with metabolic dysfunction and, possibly, has a causative role in NAFLD pathogenesis. Muscle mass is a key determinant of the whole-body insulin-mediated glucose metabolism and impacts fatty liver oxidation and energy homeostasis. These mechanisms drive the accumulation of ectopic fat both in the liver (steatosis, fatty liver) and in the muscle (myosteatosis). Myosteatosis rather than the muscle mass per se, seems to be closely associated with the severity of the liver injury. Sarcopenic obesity is a recently described entity which associates both sarcopenia and obesity and may trigger worse clinical outcomes including hepatic fibrosis progression and musculoskeletal disabilities. Furthermore, the muscle-liver-adipose tissue axis has a pivotal role in changes of the body composition, resulting in a distinct clinical phenotype that enables the identification of the “sarcopenic NAFLD phenotype.” This review aims to bring some light into the complex relationship between sarcopenia and NAFLD and critically discuss the key mechanisms linking NAFLD to sarcopenia, as well as some of the clinical consequences associated with the coexistence of these two entities: the impact of body composition phenotypes on muscle morphology, the concept of sarcopenic obesity, the relationship between sarcopenia and the severity of the liver damage and finally, the future directions and the existing gaps in the knowledge.

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Section: Clinical Evidence Linking Nafld and Sarcopeniamentioning

confidence: 99%

Section: Clinical Evidence Linking Nafld and Sarcopeniamentioning

confidence: 99%

Impact of Sarcopenia on the Severity of the Liver Damage in Patients With Non-alcoholic Fatty Liver Disease

et al. 2022

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“…However, information regarding the direct impact of sarcopenia on morbidity and mortality in patients with NAFLD is still scarce. By analysing 11 065 US individuals from the NHANES III (34% with NAFLD on ultrasonography), Kim et al now showed that, during a median follow‐up of 23 years, sarcopenia (as diagnosed by bioelectrical impedance) was associated with all‐cause mortality in individuals with NAFLD (HR 1.44, 95% CI 1.16‐1.80) but not in those without liver involvement 20 . In addition, individuals with both sarcopenia and NAFLD had a higher risk for all‐cause mortality (HR 1.28, 95% CI 1.06‐1.55), when compared to those without sarcopenia and NAFLD 20 .…”

Section: Sarcopenia and Nafld: There Is Morementioning

confidence: 99%

“…By analysing 11 065 US individuals from the NHANES III (34% with NAFLD on ultrasonography), Kim et al now showed that, during a median follow‐up of 23 years, sarcopenia (as diagnosed by bioelectrical impedance) was associated with all‐cause mortality in individuals with NAFLD (HR 1.44, 95% CI 1.16‐1.80) but not in those without liver involvement 20 . In addition, individuals with both sarcopenia and NAFLD had a higher risk for all‐cause mortality (HR 1.28, 95% CI 1.06‐1.55), when compared to those without sarcopenia and NAFLD 20 . Interestingly, sarcopenia was significantly associated with a higher risk for cancer‐ (HR 1.49, 95% CI 1.01‐2.20) and diabetes‐ (HR 4.94, 95% CI 1.70‐14.38) related mortality in patients with NAFLD only 20 .…”

Section: Sarcopenia and Nafld: There Is Morementioning

confidence: 99%

“…In addition, individuals with both sarcopenia and NAFLD had a higher risk for all‐cause mortality (HR 1.28, 95% CI 1.06‐1.55), when compared to those without sarcopenia and NAFLD 20 . Interestingly, sarcopenia was significantly associated with a higher risk for cancer‐ (HR 1.49, 95% CI 1.01‐2.20) and diabetes‐ (HR 4.94, 95% CI 1.70‐14.38) related mortality in patients with NAFLD only 20 . These findings support the notion that, in NAFLD patients with sarcopenia, physical activity and dietary interventions aimed to increase skeletal muscle mass may improve clinical outcomes 21 …”

Section: Sarcopenia and Nafld: There Is Morementioning

confidence: 99%

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A call to action for fatty liver disease

Mantovani

Valenti

2021

Liver International

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Muscle strength, but not body mass index, is associated with mortality in patients with non‐alcoholic fatty liver disease

Charatcharoenwitthaya

Karaketklang

Aekplakorn

2022

J cachexia sarcopenia muscle

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Background Whether adiposity and muscle function are associated with mortality risk in patients with non‐alcoholic fatty liver disease (NAFLD) remains unknown. We examine the independent and combined associations of body mass index (BMI) and muscle strength with overall mortality in individuals with NAFLD. Methods We analysed data from 7083 participants with NAFLD in the Thai National Health Examination Survey and their linked mortality. NAFLD was defined using a lipid accumulation product in participants without significant alcohol intake. Poor muscle strength was defined by handgrip strength of <28 kg for men and <18 kg for women, according to the Asian Working Group on Sarcopenia. The Cox proportional‐hazards model was constructed to estimate the adjusted hazard ratio (aHR) for overall mortality. Results The mean age was 49.3 ± 13.2 years, and 69.4% of subjects were women. According to the Asian‐specific criteria, 1276 individuals (18.0%) were classified as lean NAFLD (BMI 18.5–22.9 kg/m2), 1465 (20.7%) were overweight NAFLD (BMI 23–24.9 kg/m2), and 4342 (61.3%) were obese NAFLD (BMI ≥ 25 kg/m2). Over 60 432 person‐years, 843 participants died. In Cox models adjusted for physiologic, lifestyle, and comorbid factors, individuals with lean NAFLD [aHR 1.18, 95% confidence interval (CI): 0.95–1.48; P = 0.138] and subjects with overweight NAFLD (aHR 1.28, 95% CI: 0.89–1.84; P = 0.158) had mortality risk estimates similar to their obese counterparts, whereas participants with lower handgrip strength had significantly higher mortality risk than those with higher handgrip strength in men and women. Compared with obese individuals with the highest handgrip strength, elevated mortality risk was observed among men (aHR 3.21, 95% CI: 1.35–7.62, P = 0.011) and women (aHR 2.22, 95% CI, 1.25–3.93, P = 0.009) with poor muscle strength. Among men, poor muscle strength was associated with increased risk of mortality with obese NAFLD (aHR 3.94, 95% CI, 1.38–11.3, P = 0.013), overweight NAFLD (aHR 2.93, 95% CI, 1.19–7.19, P = 0.021), and lean NAFLD (aHR 2.78, 95% CI, 0.93–8.32, P = 0.065). Among women, poor muscle strength was associated with increased mortality risk with obese NAFLD (aHR 2.25, 95% CI, 1.06–4.76, P = 0.036), overweight NAFLD (aHR 1.69, 95% CI, 0.81–3.51, P = 0.153), and lean NAFLD (aHR 2.47, 95% CI, 1.06–5.73, P = 0.037). Conclusions In this nationwide cohort of individuals with NAFLD, muscle strength, but not BMI, was independently associated with long‐term overall mortality. Measuring handgrip strength can be a simple, non‐invasive risk stratification approach for overall mortality in patients with NAFLD.

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Sarcopenia in nonalcoholic fatty liver disease and all‐cause and cause‐specific mortality in the United States

Cited by 52 publications

References 40 publications

Impact of Sarcopenia on the Severity of the Liver Damage in Patients With Non-alcoholic Fatty Liver Disease

Impact of Sarcopenia on the Severity of the Liver Damage in Patients With Non-alcoholic Fatty Liver Disease

A call to action for fatty liver disease

Muscle strength, but not body mass index, is associated with mortality in patients with non‐alcoholic fatty liver disease

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