Sarcopenia and Severity of Non-Alcoholic Fatty Liver Disease

Abstract

BACKGROUND: Non-alcoholic fatty liver disease is characterized by deposition of lipids in the hepatic parenchyma exceeding 5% of liver weight in the absence of other conditions, such as viral or alcoholic hepatitis and metabolic disease. Non-alcoholic fatty liver disease is the most common form of chronic liver disease in several countries. In addition to liver complications, recent studies have shown a relation between liver fat and sarcopenia. OBJECTIVE: Determine the association between sarcopenia and the severity of non-alcoholic hepatic steatosis diagnosed by abdominal ultrasonography. METHODS: A clinical, cross-sectional study was conducted with a sample of male and female adults (18 to 70 years of age) submitted to ultrasonography for the investigation of non-alcoholic hepatic steatosis. Evaluations were also performed for the determination of upper and lower limb muscle strength. Data analysis was performed with the aid of the SPSS 22.0 program and involved ANCOVA and the Bonferroni post hoc test, with P-value <0.05 considered indicative of statistical significance. RESULTS: One hundred two patients were submitted to abdominal ultrasonography, 57.8% of whom presented some degree of non-alcoholic hepatic steatosis. The presence and degree of fatty liver infiltration were significantly associated with the sarcopenic index, determined by the ratio between upper and lower limb strength and BMI (P=0.009 and post-test P=0.028 for upper limbs; P=0.006 and post-test P=0.013 for lower limbs). CONCLUSION: In the present study, an association was found between the sarcopenic index and non-alcoholic hepatic steatosis, with an inversely proportional relation between this index and the severity of fatty infiltration. This finding offers further evidence of the metabolic interaction of the liver, adipose tissue and muscle.

Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss

“…In a population of 6451 patients with CVD, Srikanthan et al demonstrated that both disease-specific and all-cause mortality were significantly greater in those with lower compared to higher muscle mass, regardless of fat mass, indicating high muscle mass may play a protective role in CVD [199]. Sarcopenia is also independently associated with non-alcoholic fatty liver disease (NAFLD) and T2DM, both of which are risk factors for CVD [200,201]. A recent systematic review reported that gait speed and handgrip strength, both of which are used in some definitions of sarcopenia [1] and are dependent on muscle function, are associated with CVD mortality and in many of the included studies, this association was independent of traditional risk factors such as smoking and dyslipidemia [202].…”

Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease

“…Studies have also examined the relationship between NAFLD patients’ muscle strength and physical performance assessment. Cross-sectional studies have detected an association between lower muscle strength, NAFLD and liver fibrosis severity [ 37 , 62 , 63 , 64 , 65 , 66 ], and the association between SMM and NAFLD has also been investigated in children and adolescents. In a case–control study including 53 paediatric patients with NAFLD and 73 controls aged 9–15 years, the skeletal muscle-to-body fat ratio, assessed by BIA, was significantly lower in individuals with NAFLD than in those without (0.83 vs. 1.04, p = 0.005), even after adjusting for age, sex, BMI and serum glucose [ 67 ].…”

“…SARC-F, the most-used tool to screen for sarcopenia risk, has low sensitivity and positive predictive value in patients with CLD [ 153 ], but when combined with HGS and the calf circumference or finger-circle test (i.e., the determination of whether or not the maximum non-dominant calf circumference is bigger than the individual’s finger-ring circumference, which is formed by the thumb and forefinger of both hands) it is a valuable screening method for sarcopenia [ 153 ]. As regards the assessment of muscle strength, contrary to the CST, low HGS has been associated with NAFLD presence [ 37 , 63 , 64 , 65 , 66 ] and severity [ 37 , 63 , 64 ] and with the presence of advanced liver fibrosis [ 65 ]. Furthermore, low HGS predicts a poor clinical outcome [ 175 ] and mortality [ 161 , 176 ] in patients with LC.…”