Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Hepatology. 2018 Nov;68(5):1755-1768. doi: 10.1002/hep.30049. Epub 2018 Oct 14.
Nonalcoholic fatty liver disease (NAFLD) has been associated with relative skeletal muscle mass in several cross-sectional studies. We explored the effects of relative skeletal muscle mass and changes in relative muscle mass over time on the development of incident NAFLD or the resolution of baseline NAFLD in a large, longitudinal, population-based 7-year cohort study. We included 12,624 subjects without baseline NAFLD and 2943 subjects with baseline NAFLD who underwent health check-up examinations. A total of 10,534 subjects without baseline NAFLD and 2631 subjects with baseline NAFLD were included in analysis of changes in relative skeletal muscle mass over a year. Subjects were defined as having NAFLD by the hepatic steatosis index, a previously validated NAFLD prediction model. Relative skeletal muscle mass was presented using the skeletal muscle mass index (SMI), a measure of body weight-adjusted appendicular skeletal muscle mass, which was estimated by bioelectrical impedance analysis. Of the 12,624 subjects without baseline NAFLD, 1864 (14.8%) developed NAFLD during the 7-year follow-up period. Using Cox proportional hazard analysis, compared with the lowest sex-specific SMI tertile at baseline, the highest tertile was inversely associated with incident NAFLD (adjusted hazard ratio [AHR] = 0.44, 95% confidence interval [CI] = 0.38-0.51) and positively associated with the resolution of baseline NAFLD (AHR = 2.09, 95% CI = 1.02-4.28). Furthermore, compared with the lowest tertile of change in SMI over a year, the highest tertile exhibited a significant beneficial association with incident NAFLD (AHR = 0.69, 95% CI = 0.59-0.82) and resolution of baseline NAFLD (AHR = 4.17, 95% CI = 1.90-6.17) even after adjustment for baseline SMI. Conclusion: Increases in relative skeletal muscle mass over time may lead to benefits either in the development of NAFLD or the resolution of existing NAFLD.
非酒精性脂肪性肝病（NAFLD）与几个横断面研究中的相对骨骼肌质量有关。我们在一项大型、纵向、基于人群的 7 年队列研究中，探讨了相对骨骼肌质量和随时间变化的相对肌肉质量变化对新发 NAFLD 的发展或基线 NAFLD 的缓解的影响。我们纳入了 12624 名无基线 NAFLD 和 2943 名基线 NAFLD 的受试者，他们接受了健康检查。共有 10534 名无基线 NAFLD 和 2631 名基线 NAFLD 的受试者纳入了一年内相对骨骼肌质量变化的分析。NAFLD 由先前验证的 NAFLD 预测模型——肝脂肪变性指数定义。相对骨骼肌质量采用骨骼肌质量指数（SMI）表示，这是一种衡量体重调整后四肢骨骼肌质量的指标，通过生物电阻抗分析估算。在 12624 名无基线 NAFLD 的受试者中，有 1864 名（14.8%）在 7 年随访期间发生了 NAFLD。使用 Cox 比例风险分析，与基线时最低性别特异性 SMI 三分位组相比，最高三分位组与新发 NAFLD 呈负相关（调整后的危险比[AHR] = 0.44，95%置信区间[CI] = 0.38-0.51），与基线 NAFLD 的缓解呈正相关（AHR = 2.09，95%CI = 1.02-4.28）。此外，与一年内 SMI 变化最低三分位相比，最高三分位与新发 NAFLD（AHR = 0.69，95%CI = 0.59-0.82）和基线 NAFLD 的缓解（AHR = 4.17，95%CI = 1.90-6.17）显著相关，即使在调整基线 SMI 后也是如此。结论：随时间推移，相对骨骼肌质量的增加可能对 NAFLD 的发展或现有 NAFLD 的缓解产生益处。
