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Impact of non-alcoholic fatty liver disease on the risk of sarcopenia: a nationwide multicenter prospective study

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Abstract

Background and aims

Despite the association between sarcopenia and non-alcoholic fatty liver disease (NAFLD), no study has evaluated the predictive role of NAFLD in sarcopenia. We investigated impact of NAFLD on the risk of low muscle mass (LMM) and low muscle strength (LMS) in a nationwide multicenter study.

Methods

A total of 1595 community-dwelling people aged 70–84 years were followed for 2 years in the Korean Frailty and Aging Cohort Study. Muscle mass was estimated by dividing appendicular skeletal muscle mass (ASM) by body mass index (BMI). Muscle strength was measured as handgrip strength (HGS) divided by BMI. The sex-specific lowest quintiles of ASM/BMI and HGS/BMI of the study population were used as cutoffs for LMM and LMS, respectively. The risk of LMM and LMS were assessed according to hepatic steatosis index (HSI) and fatty liver index (FLI) quartiles.

Results

As HSI quartiles increased, the LMM risk increased gradually, after adjusting for age, sex, lifestyle factors, comorbidities, and several causative factors (insulin resistance, inflammation, and vitamin D) (Q4 vs. Q1 OR [95% CI] 3.46 [2.23–5.35]). The increased risk of LMS was even higher according to HSI quartiles (Q4 vs. Q1 5.81 [3.67–9.21]). Multivariate analyses based on FLI showed similar results. People with NAFLD (HSI > 36) were at higher risk of developing LMM and LMS compared to those without (1.65 [1.19–2.31] and 2.29 [1.61–3.26], respectively).

Conclusions

The presence of NAFLD may predict future risk of LMM and LMS, with greater impact on LMS than on LMM.

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Data availability

Access to anonymized data may be granted following review.

Abbreviations

ALT:

Alanine aminotransferase

ASM:

Appendicular skeletal muscle mass

AST:

Aspartate aminotransferase

BMI:

Body mass index

DXA:

Dual-energy X-ray absorptiometry

FLI:

Fatty liver index

FNIH:

Foundation for the National Institutes of Health

FPG:

Fasting plasma glucose

GGT:

γ-Glutamyl transferase

HbA1c:

Hemoglobin A1c

HGS:

Handgrip strength

HOMA-IR:

Homeostatic model assessment of insulin resistance

hs-CRP:

High-sensitivity C-reactive protein

HIS:

Hepatic steatosis index

KFACS:

Korean Frailty and Aging Cohort Study

KNHANES:

Korean National Health and Nutrition Examination Survey

LMM:

Low muscle mass

LMS:

Low muscle strength

NAFLD:

Nonalcoholic fatty liver disease

OR:

Odds ratio

SBP:

Systolic blood pressure

TG:

Triglycerides

WC:

Waist circumference

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Acknowledgements

This study was supported by grant from the Korea Health Technology R&D Project through the Korean Health Industry Development Institute (KHIDI) funded by the Ministry of Health and Welfare of Korea (grant number: HI15C3153) and grant from the National Research Foundation of Korea (NRF) funded by the Ministry of Education of Korea (grant number: 2020R1I1A1A01070499) This work was also supported by Korea University Guro Hospital (Korea Research-Driven Hospital) and grant funded by Korea University Medicine (K2115701).

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Author notes

  1. Chang Won Won and Kyung Mook Choi have contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea

    Eun Roh, Hye Jin Yoo, Sei Hyun Baik & Kyung Mook Choi

  2. Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea

    Soon Young Hwang

  3. Catholic Institute of U-Healthcare, The Catholic University of Korea, Seoul, Republic of Korea

    Jin-Hee Lee

  4. Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea

    Sang Joon Son

  5. Department of Family Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea

    Hyeon Ju Kim

  6. Department of Family Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea

    Yong Soon Park

  7. Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea

    Sam-Gyu Lee

  8. Department of Family Medicine, Center for Health Promotion and Optimal Aging, Seoul National University College of Medicine, Seoul, Republic of Korea

    Be Long Cho

  9. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Hak Chul Jang

  10. Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea

    Bong Jo Kim

  11. East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea

    Miji Kim

  12. Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea

    Chang Won Won

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  1. Eun Roh
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Contributions

ER, SYH, CWW and KMC participated in the design of the study. ER, JL, SJS, HJK, YSP, SL, BLC, HCJ, BJK, CWW and KMC contributed to data collection and quality control. SYH performed the statistical analysis. ER, HJY, SHB, CWW and KMC contributed to analysis and interpretation of data. ER, CWW and KMC wrote the paper. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chang Won Won or Kyung Mook Choi.

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Conflict of interest

Eun Roh, Soon Young Hwang, Hye Jin Yoo, Sei Hyun Baik, Jin-Hee Lee, Sang Joon Son, Hyeon Ju Kim, Yong Soon Park, Sam-Gyu Lee, Be Long Cho, Hak Chul Jang, Bong Jo Kim, Miji Kim, Chang Won Won and Kyung Mook Choi have nothing to disclose.

Ethical approval

The study was performed according to the 1964 Declaration of Helsinki. The study protocol for the KFACS was approved by the Institutional Review Board of Korea University Guro Hospital (approval no. 2020GR0134).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Roh, E., Hwang, S.Y., Yoo, H.J. et al. Impact of non-alcoholic fatty liver disease on the risk of sarcopenia: a nationwide multicenter prospective study. Hepatol Int 16, 545–554 (2022). https://doi.org/10.1007/s12072-021-10258-8

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  • DOI: https://doi.org/10.1007/s12072-021-10258-8

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