Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA.
Liver Int. 2021 Aug;41(8):1832-1840. doi: 10.1111/liv.14852. Epub 2021 Mar 11.
BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) has been associated with sarcopenia. However, mortality in the setting of NAFLD-related sarcopenia remains undefined. We aim to determine the all-cause and cause-specific mortality from sarcopenia among adults with NAFLD in the USA.
11 065 individuals in the Third National Health and Nutrition Examination Survey were studied and linked mortality through 2015 was analysed. NAFLD was diagnosed based on presence of ultrasonographic hepatic steatosis without other known liver diseases. Sarcopenia was defined as skeletal muscle index determined by bioelectrical impedance analysis. The Cox proportional hazard model was used to assess all-cause mortality and cause-specific mortality, and hazard ratio (HR) adjusted for known risk factors.
During a median follow-up of 23 years or more, sarcopenia was associated with increased all-cause mortality (HR 1.27, 95% confidence interval [CI] 1.11-1.44). Only in individuals with NAFLD, sarcopenia was associated with a higher risk for all-cause mortality, while this association was absent in those without NAFLD. Individuals with both sarcopenia and NAFLD had a higher risk for all-cause mortality (HR 1.28 95% CI 1.06-1.55) compared with those without sarcopenia and NAFLD. Furthermore, sarcopenia was associated with a higher risk for cancer- and diabetes-related mortality among those with NAFLD. This association was not noted in those without NAFLD.
In this nationally representative sample of US adults, sarcopenia was associated with a higher risk for all-cause, cancer- and diabetes-related mortality in individuals with NAFLD.
非酒精性脂肪性肝病（NAFLD）与肌肉减少症有关。然而，NAFLD 相关肌肉减少症的死亡率仍未确定。我们旨在确定美国 NAFLD 患者中肌肉减少症的全因和特定原因死亡率。
对第三次全国健康和营养检查调查中的 11065 名患者进行研究，并通过 2015 年的死亡记录进行分析。NAFLD 的诊断基于超声检查显示无其他已知肝病的肝脂肪变性。肌肉减少症的定义为生物电阻抗分析确定的骨骼肌指数。使用 Cox 比例风险模型评估全因死亡率和特定原因死亡率，并对已知危险因素进行调整后的风险比（HR）。
在中位随访 23 年或更长时间期间，肌肉减少症与全因死亡率增加相关（HR 1.27，95%置信区间 [CI] 1.11-1.44）。只有在患有 NAFLD 的个体中，肌肉减少症与全因死亡率增加相关，而在没有 NAFLD 的个体中则不存在这种相关性。患有肌肉减少症和 NAFLD 的个体全因死亡率风险更高（HR 1.28，95%CI 1.06-1.55），与没有肌肉减少症和 NAFLD 的个体相比。此外，肌肉减少症与 NAFLD 患者的癌症和糖尿病相关死亡率增加相关。在没有 NAFLD 的个体中，没有注意到这种相关性。
在这项具有全国代表性的美国成年人样本中，肌肉减少症与 NAFLD 患者的全因、癌症和糖尿病相关死亡率增加相关。
