Ohnishi Shuhei, Miyai Nobuyuki, Utsumi Miyoko, Mure Kanae, Takeshita Tatsuya, Shiba Mitsuru, Arita Mikio
Graduate School of Health and Nursing Science, Wakayama Medical University.
Department of Public Health, School of Medicine, Wakayama Medical University.
Nihon Eiseigaku Zasshi. 2019;74(0). doi: 10.1265/jjh.18031.
In this study, we aimed to examine the possible association between liver fibrosis and loss of skeletal muscle mass (SM) in community-dwelling older adults with no history of liver diseases.
A total of 2,028 older adults (mean age, 69.8 ± 5.2 years) who had not received any treatment for liver diseases and had participated in a comprehensive health survey for community residents in Wakayama, Japan were included in this study. We carried out bioelectrical impedance analysis to estimate the SM of the whole body including the arms, legs, and trunk of the subjects. Liver fibrosis was evaluated by calculating the Fib4 index based on the subject's age, AST level, ALT level, and platelet counts.
The subjects were divided into three groups according to cutoff values of the Fib4 index (low: <1.30, medium: 1.30-2.66, high: ≥2.67). The SM index (kg/m) was the lowest among subjects in the high-Fib4-index category, followed by the medium- and low-Fib4-index categories. This dose-response reduction in the SM index was more pronounced among individuals with lower blood albumin level (low nutrition) and in those with more sedentary behavior (physical inactivity). Among the selected 262 subjects who underwent SM measurement twice with an interval of 3 years, the subjects with a high Fib4 index showed greater reduction in the SM index than those with medium and low Fib4 indices. Multiple regression analysis revealed that the Fib4 index was significantly associated with the SM index, independent of age, sex, albumin level, sedentary behavior, diabetes mellitus, alcohol intake, and smoking status.
The present findings suggest that the potential progression of liver fibrosis is associated with the excessive loss of SM among apparently healthy older adults without any treatment for liver diseases.
在本研究中，我们旨在探讨在无肝脏疾病史的社区居住老年人中，肝纤维化与骨骼肌量（SM）丢失之间可能存在的关联。
本研究纳入了2028名未接受过任何肝脏疾病治疗且参与了日本和歌山县社区居民综合健康调查的老年人（平均年龄69.8±5.2岁）。我们进行了生物电阻抗分析，以估计受试者包括手臂、腿部和躯干在内的全身SM。通过根据受试者的年龄、AST水平、ALT水平和血小板计数计算Fib4指数来评估肝纤维化。
根据Fib4指数的临界值将受试者分为三组（低：<1.30，中：1.30 - 2.66，高：≥2.67）。高Fib4指数组受试者的SM指数（kg/m）最低，其次是中Fib4指数组和低Fib4指数组。这种SM指数的剂量反应性降低在血白蛋白水平较低（营养状况差）和久坐行为较多（身体活动少）的个体中更为明显。在间隔3年进行两次SM测量的262名选定受试者中，Fib4指数高的受试者的SM指数下降幅度大于Fib4指数中等和低的受试者。多元回归分析显示，Fib4指数与SM指数显著相关，不受年龄、性别、白蛋白水平、久坐行为、糖尿病、酒精摄入和吸烟状况的影响。
目前的研究结果表明，在未接受任何肝脏疾病治疗的看似健康的老年人中，肝纤维化的潜在进展与SM的过度丢失有关。
