Betty and Guy Beatty Center for Integrated Research, Inova Health SystemFalls ChurchVirginiaUSA.
Center for Liver Disease, Department of MedicineInova Fairfax Medical CampusFalls ChurchVirginiaUSA.
Hepatol Commun. 2022 Nov;6(11):3140-3153. doi: 10.1002/hep4.2061. Epub 2022 Aug 10.
Chronic liver diseases (CLDs) are associated with increased morbidity and mortality. Sarcopenia is an important complication of CLD that can be impacted by several modifiable risk factors. Our aim was to assess the associations between healthy living, sarcopenia, and long-term outcomes among patients with CLD. We used the Third National Health and Nutrition Examination Survey data with National Death Index-linked mortality files. We used the American Heart Association's Life's Simple 7 (LS7) metrics as surrogates of healthy living. The study included 12,032 subjects (34.9% CLDs [0.5% hepatitis B virus (HBV), 1.8% hepatitis C virus (HCV), 5.7% alcohol-associated liver disease (ALD), 26.9% nonalcoholic fatty liver disease (NAFLD)] and 65.1% controls). Prevalence of sarcopenia was higher among NAFLD than other CLDs and the controls (40.7% in NAFLD, 27.2% in ALD, 22.4% in HCV, 16.8% in HBV, and 18.5% in controls; p < 0.001). Among NAFLD and ALD, patients with sarcopenia were less likely to meet ideal LS7 metrics than those without sarcopenia. During 27 years of follow-up, among 4 patients with CLDs and the controls, all-cause cumulative mortality was highest among patients with HCV (35.2%), followed by ALD (34.7%) and NAFLD (29.6%). The presence of sarcopenia was associated with higher risk of all-cause mortality only among subjects with NAFLD (hazard ratio [HR] 1.24; 95% confidence interval [CI] 1.01-1.54; p = 0.04). Among subjects with NAFLD, presence of sarcopenia was associated with higher risk of cardiovascular-specific (HR 2.28 [1.71-3.05; p < 0.01]), cancer-specific (HR 1.90 [1.37-2.65]; p < 0.01), diabetes-specific (HR 6.42 [2.87-14.36]; p < 0.01), and liver-specific mortality (HR 2.49 [1.08-5.76]; p = 0.04). The multivariable model showed that component of LS7 metrics that provided the strongest protection against sarcopenia were ideal body mass index, ideal blood pressure, ideal physical activity, and ideal glycemic control among subjects with NAFLD subjects. Conclusions: Among subjects with NAFLD, sarcopenia is associated with a higher risk of all-cause mortality and liver mortality. Attainment of ideal LS7 metrics provides protection against sarcopenia in NAFLD.
慢性肝病 (CLD) 与发病率和死亡率的增加有关。肌肉减少症是 CLD 的一个重要并发症，可受到多种可改变的危险因素的影响。我们的目的是评估健康生活、肌肉减少症与 CLD 患者的长期预后之间的关联。我们使用了第三次国家健康和营养检查调查数据以及与国家死亡指数相关的死亡率文件。我们使用美国心脏协会的“生活简单 7 项指标” (LS7) 作为健康生活的替代指标。该研究纳入了 12032 名受试者（34.9%的 CLD [0.5%乙型肝炎病毒 (HBV)，1.8%丙型肝炎病毒 (HCV)，5.7%酒精性肝病 (ALD)，26.9%非酒精性脂肪性肝病 (NAFLD)] 和 65.1%的对照组）。与其他 CLD 和对照组相比，NAFLD 患者中肌肉减少症的患病率更高 (NAFLD 中为 40.7%，ALD 中为 27.2%，HCV 中为 22.4%，HBV 中为 16.8%，对照组中为 18.5%；p<0.001)。在 NAFLD 和 ALD 中，与无肌肉减少症的患者相比，有肌肉减少症的患者更不可能达到理想的 LS7 指标。在 27 年的随访中，在 4 名 CLD 患者和对照组中，所有原因的累积死亡率在 HCV 患者中最高 (35.2%)，其次是 ALD (34.7%)和 NAFLD (29.6%)。只有在患有 NAFLD 的受试者中，肌肉减少症的存在与全因死亡率的风险增加相关 (风险比 [HR] 1.24；95%置信区间 [CI] 1.01-1.54；p=0.04)。在患有 NAFLD 的受试者中，肌肉减少症的存在与心血管疾病特异性死亡 (HR 2.28 [1.71-3.05；p<0.01])、癌症特异性死亡 (HR 1.90 [1.37-2.65]；p<0.01)、糖尿病特异性死亡 (HR 6.42 [2.87-14.36]；p<0.01) 和肝脏特异性死亡 (HR 2.49 [1.08-5.76]；p=0.04) 的风险增加相关。多变量模型显示，在 NAFLD 受试者中，LS7 指标中对肌肉减少症提供最强保护作用的成分是理想的体重指数、理想的血压、理想的体力活动和理想的血糖控制。结论：在患有 NAFLD 的受试者中，肌肉减少症与全因死亡率和肝脏死亡率的风险增加相关。达到理想的 LS7 指标可以预防 NAFLD 患者的肌肉减少症。
