Prevalence of sarcopenia using different methods in patients with non-alcoholic fatty liver disease

Abstract

BACKGROUND Sarcopenia is a clinical condition associated with several liver diseases and it includes non-alcoholic fatty liver disease (NAFLD) in its broad spectrum as steatosis, steatohepatitis and fibrosis. However, the criteria to define sarcopenia are diverse, and even those established in consensus have been discussed regarding their performance in making an accurate diagnosis. AIM To evaluate the prevalence of sarcopenia, using different methods, in patients with NAFLD, and its association with clinical-anthropometric parameters. METHODS This was an observational study of outpatients with NAFLD. Sarcopenia was defined by the European Working Group Consensus on Sarcopenia in Older People of 2010 (EWGSOP1) and 2018 (EWGSOP2). The skeletal muscle index was used to estimate muscle mass, handgrip strength was assessed using the dynamometer and physical performance by walking a distance of four meters at usual walking speed. The non-invasive fibrosis scores, fibrosis-4 (FIB-4) index and Aspartate aminotransferase to platelet ratio index (APRI), were used to assess the absence and presence of fibrosis. RESULTS Fifty-seven individuals with NAFLD were evaluated, the mean age (SD) was 52.7 (11.3) years and 75.4% were female. Fibrosis assessed by FIB-4 and APRI was observed in 3.7% and 16.6% of patients with NAFLD, respectively. The diagnosis of sarcopenia was identified only by EWGSOP1 in 3.5% of NAFLD patients, and the prevalence of probable/pre-sarcopenia was higher using the EWGSOP2 consensus at 26.3%, when compared to 1.8% with EWGSOP1. Sarcopenia defined by EWGSOP1, was associated with grade I steatosis, but without overweight ( P < 0.05). An association between sarcopenia and fibrosis was not observed ( P > 0.05). EWGSOP2 showed a greater number of patients with probable sarcopenia, and who were overweight (12 (80.0%)), with a higher degree of steatosis [11 (73.3%) and presence of fibrosis (1 (6.7%), FIB-4 and 3 (20.0%), APRI] compared to EWGSOP1 [1 (100%), 0 (0.0%), 0 (0.0%), FIB-4 and 0 (0.0%), APRI, respectively]. CONCLUSION The present study showed that sarcopenia in NAFLD was not predominant in patients without fibrosis, by both diagnostic methods. In addition, the prevalence of probable sarcopenia also depends on the method applied.

Agreement and diagnostic differences among three definitions of sarcopenia in patients with chronic hepatitis C

“…Differently, in a previous investigation that included 114 hospitalized patients with cirrhosis, the proportion of individuals categorized as having low muscle strength, an indicator of probable sarcopenia, was significantly reduced when EWGSOP2 (3.5%) was compared with EWGSOP1 (30.7%) 14 . In contrast to these data, more recently, in an investigation targeting muscle wasting in outpatients with nonalcoholic fatty liver disease, according to EWGSOP2, the prevalence of probable sarcopenia reached 26.3%; however, when using the EWGSOP1 criteria, the prevalence was 1.8% 16 …”

“…14 In contrast to these data, more recently, in an investigation targeting muscle wasting in outpatients with nonalcoholic fatty liver disease, according to EWGSOP2, the prevalence of probable sarcopenia reached 26.3%; however, when using the EWGSOP1 criteria, the prevalence was 1.8%. 16 In most previous studies targeting older adult individuals, the prevalence of sarcopenia reduced when the revised criteria of sarcopenia, the EWGSOP2, were used. 32,33 This finding points to a reduction in sarcopenia prevalence due to modifications in the cutoffs to determine low muscle mass and strength compared with the original consensus, the EWGSOP1.…”

“…Although previous investigations appraised whether the variance in the prevalence of sarcopenia in patients with chronic hepatic diseases was associated with different consensus criteria, 9,14–17 we are not aware of studies on this subject in patients with chronic hepatitis C. Therefore, we aimed to evaluate the prevalence of sarcopenia and the agreement and discrepancies between different operational criteria of sarcopenia, including the original EWGSOP1, the revised EWGSOP2, and FNIH definitions, in patients with chronic hepatitis C.…”

Vitamin D improves hepatic steatosis in NAFLD via regulation of fatty acid uptake and β-oxidation

“…The FLI was calculated using the following equation: FLI = (e 0.953×ln(TG) + 0.139×BMI + 0.718 × ln(γGT) + 0.053 × WC – 15.745 )/(1 + e 0.953×ln(TG) + 0.139×BMI + 0.718 × ln(γGT) + 0.053 × WC – 15.745 ) × 100. The cases were individually divided into the following two groups based on the NFS and FIB-4: no advanced fibrosis (NFS<-1.455 or FIB-4<1.30) and fibrosis (NFS≥-1.455 or FIB-4≥1.30) ( 53 , 54 ). Based on an FLI cutoff of 60, the cases were divided into the following two groups: no fatty liver (FLI <60) and fatty liver (FLI≥60).…”

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

“…The prevalence of sarcopenia is significantly increased in NAFLD, ranging from 12.2% to 43.6% [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ], and in NASH (about 35%) [ 23 ], compared to that in non-NAFLD patients, ranging from 8% to 9.7% [ 23 , 26 ]. On the other hand, some studies have identified a low prevalence of sarcopenia in NAFLD patients, ranging between 3.5% [ 30 ] and 4.5% [ 31 ]. This high heterogeneity is probably due to the differences among studies in the definition and assessment of sarcopenia, NAFLD and NASH.…”