Department of Internal Medicine, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal -
Department of Biomedicine, Faculty of Medicine of the University of Porto, Porto, Portugal -
Minerva Gastroenterol (Torino). 2023 Sep;69(3):374-381. doi: 10.23736/S2724-5985.22.03097-2. Epub 2022 Mar 28.
Non-alcoholic fatty liver disease (NAFLD) is a rising global health issue. The influence of muscle in its pathophysiology has recently gained attention. Our aim was to investigate the association of low muscle mass, strength, and performance with the presence and severity of NAFLD.
Patients with metabolic syndrome followed in an outpatient clinic, were consecutively included, between April 1 and December 31, 2019. Abdominal ultrasound for the diagnosis of NAFLD, NAFLD fibrosis score (NFS) and Fibrosis-4 Index (FIB-4) for determination of significant fibrosis, dual-energy X-ray absorptiometry for calculation of skeletal muscle index (SMI = appendicular skeletal mass / weight x100) and sarcopenic index (SI = appendicular skeletal mass / Body Mass Index), and the Short Physical Performance Battery for muscle strength and performance assessment were performed. Sarcopenia was defined as low muscle strength and low SMI or SI.
A total of 157 patients were included, of which 68.8% had NAFLD, 66.2% low SMI, 50.3% low SI, 16.6% low performance and 11.5% low strength. In patients with NAFLD, prevalence of significant fibrosis by NFS was 15.7%. Low SMI was associated with presence of NAFLD when adjusted for age, sex, type 2 diabetes mellitus, hypertension, and dyslipidemia, but not for body mass index and waist circumference. Low SMI, low SI, and sarcopenia were associated with significant fibrosis in univariate analysis; the small number of events precluded a multivariable analysis.
Low SMI was associated with NAFLD independently of demographics and comorbidities but not of other parameters of body composition. This contrasts with most studies published on this matter.
非酒精性脂肪性肝病（NAFLD）是一个日益严重的全球性健康问题。肌肉在其病理生理学中的作用最近受到了关注。我们的目的是研究肌肉质量低、肌肉力量低和肌肉功能差与 NAFLD 的存在和严重程度之间的关系。
2019 年 4 月 1 日至 12 月 31 日，连续纳入在门诊就诊的代谢综合征患者。采用腹部超声诊断 NAFLD，NAFLD 纤维化评分（NFS）和 Fibrosis-4 指数（FIB-4）来确定显著纤维化，双能 X 线吸收法来计算骨骼肌指数（SMI=四肢骨骼肌质量/体重×100）和肌少症指数（SI=四肢骨骼肌质量/体重指数），并采用短体物理性能电池来评估肌肉力量和表现。肌少症定义为肌肉力量低和 SMI 或 SI 低。
共纳入 157 例患者，其中 68.8%患有 NAFLD，66.2%的患者 SMI 低，50.3%的患者 SI 低，16.6%的患者肌肉功能差，11.5%的患者肌肉力量低。在患有 NAFLD 的患者中，NFS 显著纤维化的患病率为 15.7%。在校正年龄、性别、2 型糖尿病、高血压和血脂异常后，低 SMI 与 NAFLD 的存在相关，但与体重指数和腰围无关。在单变量分析中，低 SMI、低 SI 和肌少症与显著纤维化相关；由于事件数量少，无法进行多变量分析。
低 SMI 与 NAFLD 独立相关，与人口统计学和合并症无关，但与身体成分的其他参数无关。这与大多数关于这个问题的研究结果不同。
