Nonalcoholic Fatty Liver Disease Is Associated With Low Skeletal Muscle Mass in Overweight/Obese Youths

Abstract

Background: Recent studies in adult non-elderly and elderly individuals have reported a link between nonalcoholic fatty liver disease (NAFLD) and sarcopenia. Nonetheless, whether this relationship would be found outside these populations it is still unknown. Hence, we evaluated the relationship between NAFLD and skeletal muscle mass in children and adolescents with overweight/obesity. Methods: Two-hundred and thirty-four overweight/obese youths were enrolled. NAFLD was diagnosed by ultrasononography, after exclusion of infectious and metabolic disorders. Forty of the patients with NAFLD had also liver biopsy. Total and regional lean body mass and total fat mass measurements were obtained by dual-energy X-ray absorptiometry. The relative muscle mass (RMM) was defined as the percent of muscle mass (kg) relative to the sum of muscle and fat (kg) mass. Appendicular skeletal muscle mass (ASM) was calculated by the sum of muscle masses of the four limbs (kg), and expressed as percent of body weight. Results: Subjects were stratified according to tertiles of RMM. The prevalence of abdominal obesity, dyslipidemia, insulin resistance, metabolic syndrome, NAFLD as well as biopsy-proven nonalcoholic steatohepatitis (NASH) was significantly increased in the lowest tertile of RMM. After controlling for age, sex and Tanner stage, children in the lowest tertile of RMM had an increased risk for NAFLD (OR= 2.80, 95% CI=1.57-5.02) compared to those in the other two tertiles. This association persisted after additional adjustments for clinical and metabolic variables. Similarly, the risk of NAFLD in the lowest tertile of ASM/weight index was significantly higher compared to those in the other two tertiles after adjustment for the above confounders. Conclusions: This is the first study to establish an independent association between low muscle mass and NAFLD/NASH in overweight/obese youths. Considering the worldwide increase of pediatric obesity, measurements of muscle mass may serve as useful method of identifying among obese children those at high metabolic risk who may need intensive lifestyle interventions to prevent NAFLD and its progression.

Decreased Muscle-to-Fat Mass Ratio Is Associated with Low Muscular Fitness and High Alanine Aminotransferase in Children and Adolescent Boys in Organized Sports Clubs

“…In children and adolescents with a BMI above the 85th percentile, screening for NAFLD is recommended by the NASPGHAN Clinical Practice Guideline [ 14 ]. However, recently, decreased ASM values and ASM/FM imbalance have been identified as risk factors for NAFLD in children and adolescents with or without obesity [ 17 , 18 ]. NAFLD in non-obese adolescents has been associated with a high rate of sarcopenia [ 18 ], defined as an MFR value of ≤1.155 [ 27 ].…”

“…In fact, improvement in the muscle-to-fat mass ratio (MFR), rather than improvement in the body mass index (BMI), has led to an improvement in the liver stiffness in adults with NAFLD [ 16 ]. An imbalance in the MFR and decreased skeletal muscle mass have also been identified as risk factors for pediatric NAFLD [ 17 , 18 ]. Therefore, it is extremely important to evaluate not only BMI (simple weight-to-height ratio) but also MFR in those with NAFLD.…”

Changes in body composition and low blood urea nitrogen level related to an increase in the prevalence of fatty liver over 20 years: A cross‐sectional study

“…A recent study reported an association between BC change and FL, even in children and adolescents. 22 Visceral fat gain and muscle loss are primarily related to aging; however, they now appear to be significant problems in all ages, from children to the elderly. These findings suggest that there is some factor common to a wide range of ages that mighty be related to the pathogenesis of this BC change.…”

Качество Жизни Детей С Неалкогольной Жировой Болезнью Печени

“…У дорослих і в педіатричних пацієнтів із НАЖХП часто спостерігаються дисліпідемія, інсулінорезистентність, гіпертензія та інші компоненти метаболічного синдрому, що асоціюються з підвищеним ризиком розвитку цукрового діабету другого типу та серцево-судинних захворювань [5,6]. Крім того, діти з НАЖХП характеризуються низькою мінеральною щільністю кісткової тканини, зменшенням маси скелетних м'язів, більш вираженим у хворих із НАСГ, значною частотою виявлення психоемоційних розладів, порушенням соціальної адаптації, що призводить до погіршення якості життя хворих [7,8].…”