The relationship between metabolic dysfunction‐associated fatty liver disease and low muscle mass in an asymptomatic Korean population

Abstract

Background Metabolic (dysfunction)‐associated fatty liver disease (MAFLD) emphasizes the metabolic dysfunction in nonalcoholic fatty liver disease (NAFLD). Although the relationship between low muscle mass and NAFLD has been suggested, the effect of MAFLD on low muscle mass is yet to be investigated. In this study, we examined the relationship between MAFLD and low muscle mass in an asymptomatic Korean population. Methods Examinees who underwent FibroScan® and bioelectrical impedance analyses on the same day during the period of June 2017 to December 2019 were included. Hepatic steatosis was diagnosed using controlled attenuation parameter (CAP) with two cut‐off values of 248 and 294 dB/m. Low muscle mass was defined based on appendicular skeletal muscle mass/body weight (wt) or body mass index (BMI) ratios of two standard deviations below the sex‐specific mean for healthy young adults. Subjects were divided into four subgroups: diabetic MAFLD (presence of diabetes mellitus [DM]), metabolic dysfunction (MD) MAFLD (≥2 metabolic abnormalities without DM), overweight MAFLD (overweight/obese without DM and <2 metabolic abnormalities) and no MAFLD. Results Among all of the 6414 subjects (mean 53.9 years of age; 85.4% male), the prevalence of MAFLD was 49.9% and 22.7% for CAP cut‐off values of 248 and 294 dB/m, respectively. In the multivariate analysis, MAFLD was associated with an increased risk of both low muscle mass_wt (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.38–2.35, P < 0.001) and low muscle mass_BMI (OR 1.31, 95% CI 1.01–1.70, P = 0.042). The risk of low muscle mass_wt and low muscle mass_BMI increased the most in the diabetic MAFLD subgroup compared with the no‐MAFLD group (OR 2.11, 95% CI 1.51–2.96, P < 0.001 and OR 1.51, 95% CI 1.08–2.13, P = 0.017). There was an increased risk of low muscle mass_wt in the MD MAFLD subgroup (OR 1.73, 95% CI 1.31–2.28, P < 0.001). Comparable results were observed when the CAP cut‐off value of 294 dB/m was applied. Conclusions The presence of MAFLD is significantly associated with increased risk of low muscle mass with varying risks according to the MAFLD subgroups. Clinicians should be aware of the differentiated risk of low muscle mass across the subgroups of MAFLD.

Prevalence of Sarcopenia and Its Defining Components in Non-alcoholic Fatty Liver Disease Varies According to the Method of Assessment and Adjustment: Findings from the UK Biobank

“…On average, those with NAFLD had significantly higher BMI and absolute (kg) muscle mass but when adjusted for BMI the prevalence ratio of low muscle mass was significantly higher in those with NAFLD; the opposite finding was observed when adjusted for height 2 . Previous studies have also reported a higher prevalence of low muscle mass when adjusting for BMI in those with NAFLD (8.7% vs 3.6%) [ 36 ] and no differences when adjusting for height 2 [ 5 ]. This suggests that it is important to account for adiposity when evaluating the influence of NAFLD on muscle mass, especially in overweight and obese cohorts.…”

Increased visceral fat area to skeletal muscle mass ratio is positively associated with the risk of metabolic dysfunction-associated steatotic liver disease in a Chinese population

“…Additionally, Yu et al’s study concluded that a lower appendicular skeletal muscle mass to visceral fat area ratio is linked to a higher prevalence of subtypes of metabolic associated fatty liver disease [ 38 ]. Some mechanisms could elucidate the combined impact of reduced SMM and increased VFA on NAFLD risk, including IR, impaired lipid metabolism, and low-grade inflammation [ 24 , 39 ]. Skeletal muscles serve as a site for insulin-mediated glucose uptake.…”

“…According to manufacturer’s instruction, subjects were light dressed and instructed to hold the analyzer’s handles, making contact with the electrodes on each limb. They extended their limbs to prevent their arms from touching the torso, kept their thighs from making contact and maintained a still position throughout the measurement [ 24 ]. The BIA method was validated as the reliable technique for assessing body composition, showing strong correlations with measurements obtained utilizing abdominal computed tomography and dual-energy X-ray absorptiometry (DXA), including VFA and SMM [ 25 , 26 ].…”

Impact of non‐obese metabolic dysfunction‐associated fatty liver disease on risk factors for the recurrence of esophageal squamous cell carcinoma treated with endoscopic submucosal dissection: A multicenter study

“…Seo et al. revealed that, in 6414 asymptomatic Korean individuals, there was an increased risk of low muscle mass in the non‐obese MAFLD subgroup, as compared with the control subgroup 40 . Sun et al.…”

“…revealed that, in 6414 asymptomatic Korean individuals, there was an increased risk of low muscle mass in the non-obese MAFLD subgroup, as compared with the control subgroup. 40 Sun et al also performed a propensity score-matched population-based cohort study to demonstrate that sarcopenia is a significant risk factor for the onset of esophageal cancer. 41 Thus, patients with non-obese MAFLD may be related to the high ESCC recurrence rates through the number of metabolic dysfunction and sarcopenia.…”