Fatty Liver Index Associates with Relative Sarcopenia and GH/ IGF- 1 Status in Obese Subjects

Abstract

IntroductionRecently the association between hepatic steatosis and sarcopenia has been described. GH/IGF-1 axis has been postulated to play a role in linking fatty liver and low muscle mass. The aim of our study was to explore the association between fatty liver index, sarcopenic obesity, insulin sensitivity, and GH/IGF-1 status.Methods427 subjects [age: 45.65±13.94 years, BMI: 36.92±6.43 kg/m2] were enrolled. Participants were divided into three groups: fatty liver index (FLI) <20, 20≥FLI<60, and FLI≥60. Body composition was assessed by DXA. The truncal fat mass (TrFM) to appendicular skeletal muscle (ASM) ratio was used as an indicator of sarcopenic obesity. ISI-Matsuda index was used.ResultsBMI, fat mass, and the TrFM/ASM ratio were higher in subjects with FLI≥60. GH, IGF-1 and ISI-Matsuda were lower in the high FLI group (all p<0.05). A significantly positive correlation between FLI and TrFM/ ASM ratio (r = 0.221, p<0.001) was found, whereas FLI levels were negatively correlated with ISI- Matsuda (r = -0.335, p<0.001), GH (r = -0.200, p = 0.006), and IGF- 1 levels (r = -0.157, p = 0.028). Stepwise linear regression analysis showed that GH levels were significantly negatively correlated with FLI, while the TrFM/ ASM ratio was positively associated with FLI, after adjustment for age, BMI, total fat mass, truncal fat mass, fat- free mass, and ISI- Matsuda.ConclusionsImpairment of GH/IGF-1 axis seems to be associated to the risk of the development of sarcopenic obesity and ectopic fat deposition in the liver. Metabolic and hormonal derangements as determinants of ectopic fat deposition and body composition deserve to be evaluated in obese subjects.

Visceral adipose tissue dysfunction and mortality among a population-based sample of males and females

“…VAT is a metabolically-active endocrine organ that is associated with circulating biomarkers, such as triglycerides, HDL cholesterol, and GGT [2,3]. The VAI and FLI also correlate with insulin resistance, which is often observed among adults with excess VAT [4,7], and is a risk factor for cardiovascular disease and cancer [10]. Therefore metrics such as the VAI or FLI which simultaneously integrate measures of VAT quantity (i.e., VAT volume or area) and quality (i.e., VAT metabolic activity) may be an important first step to globally characterize VAT dysfunction and help to differentiate patients with metabolically healthy obesity versus patients with metabolically unhealthy obesity [11].…”

“…The FLI ranges from 0–100, with higher values indicating a greater likelihood of having hepatic steatosis [5]. The FLI is associated with abdominal fat mass ( r =0.662; P <0.001) and insulin sensitivity ( r =−0.335; P <0.001) in obese adults in the general population [7]. …”

The Challenges of Nutritional Assessment in Cirrhosis

“…An additional factor associated with sarcopenic obesity and potentially useful in the overall assessment of NASH patients is gamma-glutamyl tranferase level (GGT) [53], as elevated GGT levels were associated with increased risk of sarcopenia and sarcopenic obesity in a cohort of patients older than 50 years. Growth hormone (GH) and insulin- like growth factor 1 (IGF- 1) were also associated with increased risk of sarcopenic obesity and hepatic fat deposition [54]. …”

Growth Hormone Replacement Therapy in Patients without Adult Growth Hormone Deficiency: What Answers Do We Have So Far?

“…Several studies have shown that GH secretion is compromised in obese people, and GH and IGF-1 have been found to be involved in fatty infiltration of the liver [21]. On the other hand, the ectopic deposition of fat seems to be associated with reduced GH levels, as well as the decreased ability to produce GH with aging, which is one of the causes of body changes leading to excess adiposity and sarcopenia [22].…”