NAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou325000, People's Republic of China.
Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.
Br J Nutr. 2022 Jun 14;127(11):1613-1620. doi: 10.1017/S0007114521002415. Epub 2021 Jun 28.
Sarcopenic obesity is regarded as a risk factor for the progression and development of non-alcoholic fatty liver disease (NAFLD). Since male sex is a risk factor for NAFLD and skeletal muscle mass markedly varies between the sexes, we examined whether sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio (SVR), that is, an index of skeletal muscle mass combined with abdominal obesity, and the histological severity of NAFLD. The SVR was measured by bioelectrical impedance in a cohort of 613 (M/F = 443/170) Chinese middle-aged individuals with biopsy-proven NAFLD. Multivariable logistic regression and subgroup analyses were used to test the association between SVR and the severity of NAFLD (i.e. non-alcoholic steatohepatitis (NASH) or NASH with the presence of any stage of liver fibrosis). NASH was identified by a NAFLD activity score ≥5, with a minimum score of 1 for each of its categories. The presence of fibrosis was classified as having a histological stage ≥1. The SVR was inversely associated with NASH in men (adjusted OR 0·62; 95 % CI 0·42, 0·92, = 0·017 for NASH, adjusted OR 0·65; 95 % CI 0·43, 0·99, = 0·043 for NASH with the presence of fibrosis), but not in women (1·47 (95 % CI 0·76, 2·83), = 0·25 for NASH, and 1·45 (95 % CI 0·74, 2·83), = 0·28 for NASH with the presence of fibrosis). There was a significant interaction for sex and SVR ( = 0·017 for NASH and = 0·033 for NASH with the presence of fibrosis). Our findings show that lower skeletal muscle mass combined with abdominal obesity is strongly associated with the presence of NASH only in men.
肌肉减少性肥胖被认为是非酒精性脂肪性肝病（NAFLD）进展和发展的一个危险因素。由于男性是 NAFLD 的一个危险因素，而且男女之间的骨骼肌质量差异显著，因此我们研究了性别是否会影响四肢骨骼肌与内脏脂肪面积比（SVR）的关系，即结合腹型肥胖的骨骼肌质量指数，与 NAFLD 的组织学严重程度之间的关系。SVR 通过生物电阻抗法在 613 名（男/女=443/170）经活检证实患有 NAFLD 的中国中年人群中进行测量。采用多变量逻辑回归和亚组分析来检验 SVR 与 NAFLD 严重程度（即非酒精性脂肪性肝炎（NASH）或 NASH 伴任何阶段的肝纤维化）之间的关系。NASH 通过 NAFLD 活动评分≥5 来确定，每个分类的最小得分为 1。纤维化的存在被分为组织学分期≥1。SVR 与男性的 NASH 呈负相关（调整后的比值比 0.62；95%可信区间 0.42，0.92， = 0.017 用于 NASH，调整后的比值比 0.65；95%可信区间 0.43，0.99， = 0.043 用于 NASH 伴纤维化），但与女性无关（1.47（95%可信区间 0.76，2.83）， = 0.25 用于 NASH，和 1.45（95%可信区间 0.74，2.83）， = 0.28 用于 NASH 伴纤维化）。性别和 SVR 之间存在显著的交互作用（ = 0.017 用于 NASH， = 0.033 用于 NASH 伴纤维化）。我们的研究结果表明，较低的骨骼肌质量结合腹型肥胖与男性的 NASH 存在强烈相关。
