Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Cachexia Sarcopenia Muscle. 2022 Oct;13(5):2393-2404. doi: 10.1002/jcsm.13001. Epub 2022 Aug 26.
Whether adiposity and muscle function are associated with mortality risk in patients with non-alcoholic fatty liver disease (NAFLD) remains unknown. We examine the independent and combined associations of body mass index (BMI) and muscle strength with overall mortality in individuals with NAFLD.
We analysed data from 7083 participants with NAFLD in the Thai National Health Examination Survey and their linked mortality. NAFLD was defined using a lipid accumulation product in participants without significant alcohol intake. Poor muscle strength was defined by handgrip strength of <28 kg for men and <18 kg for women, according to the Asian Working Group on Sarcopenia. The Cox proportional-hazards model was constructed to estimate the adjusted hazard ratio (aHR) for overall mortality.
The mean age was 49.3 ± 13.2 years, and 69.4% of subjects were women. According to the Asian-specific criteria, 1276 individuals (18.0%) were classified as lean NAFLD (BMI 18.5-22.9 kg/m ), 1465 (20.7%) were overweight NAFLD (BMI 23-24.9 kg/m ), and 4342 (61.3%) were obese NAFLD (BMI ≥ 25 kg/m ). Over 60 432 person-years, 843 participants died. In Cox models adjusted for physiologic, lifestyle, and comorbid factors, individuals with lean NAFLD [aHR 1.18, 95% confidence interval (CI): 0.95-1.48; P = 0.138] and subjects with overweight NAFLD (aHR 1.28, 95% CI: 0.89-1.84; P = 0.158) had mortality risk estimates similar to their obese counterparts, whereas participants with lower handgrip strength had significantly higher mortality risk than those with higher handgrip strength in men and women. Compared with obese individuals with the highest handgrip strength, elevated mortality risk was observed among men (aHR 3.21, 95% CI: 1.35-7.62, P = 0.011) and women (aHR 2.22, 95% CI, 1.25-3.93, P = 0.009) with poor muscle strength. Among men, poor muscle strength was associated with increased risk of mortality with obese NAFLD (aHR 3.94, 95% CI, 1.38-11.3, P = 0.013), overweight NAFLD (aHR 2.93, 95% CI, 1.19-7.19, P = 0.021), and lean NAFLD (aHR 2.78, 95% CI, 0.93-8.32, P = 0.065). Among women, poor muscle strength was associated with increased mortality risk with obese NAFLD (aHR 2.25, 95% CI, 1.06-4.76, P = 0.036), overweight NAFLD (aHR 1.69, 95% CI, 0.81-3.51, P = 0.153), and lean NAFLD (aHR 2.47, 95% CI, 1.06-5.73, P = 0.037).
In this nationwide cohort of individuals with NAFLD, muscle strength, but not BMI, was independently associated with long-term overall mortality. Measuring handgrip strength can be a simple, non-invasive risk stratification approach for overall mortality in patients with NAFLD.
非酒精性脂肪性肝病（NAFLD）患者的肥胖和肌肉功能与死亡风险之间的关系尚不清楚。我们研究了体重指数（BMI）和肌肉力量与 NAFLD 患者总体死亡率的独立和联合关联。
我们分析了泰国国家健康检查调查中 7083 名 NAFLD 患者的数据及其相关死亡率。在没有大量饮酒的参与者中，使用脂质蓄积产物定义 NAFLD。根据亚洲肌少症工作组的标准，男性握力<28kg 和女性握力<18kg 定义为肌肉力量差。使用 Cox 比例风险模型估计总体死亡率的调整后的危险比（aHR）。
平均年龄为 49.3±13.2 岁，69.4%的受试者为女性。根据亚洲特有的标准，1276 名（18.0%）患者被归类为瘦型 NAFLD（BMI 18.5-22.9kg/m2），1465 名（20.7%）为超重 NAFLD（BMI 23-24.9kg/m2），4342 名（61.3%）为肥胖型 NAFLD（BMI≥25kg/m2）。在超过 60432 人年的随访期间，843 名参与者死亡。在调整生理、生活方式和合并症因素的 Cox 模型中，瘦型 NAFLD 患者（aHR 1.18，95%置信区间[CI]：0.95-1.48；P=0.138）和超重 NAFLD 患者（aHR 1.28，95%CI：0.89-1.84；P=0.158）的死亡风险估计与肥胖患者相似，而男性和女性中握力较低的参与者的死亡率风险显著高于握力较高的参与者。与肥胖且握力最强的个体相比，男性（aHR 3.21，95%CI：1.35-7.62，P=0.007）和女性（aHR 2.22，95%CI，1.25-3.93，P=0.005）握力差者的死亡率风险较高。在男性中，肌肉力量差与肥胖型 NAFLD（aHR 3.94，95%CI，1.38-11.3，P=0.011）、超重 NAFLD（aHR 2.93，95%CI，1.19-7.19，P=0.021）和瘦型 NAFLD（aHR 2.78，95%CI，0.93-8.32，P=0.065）的死亡风险增加相关。在女性中，肌肉力量差与肥胖型 NAFLD（aHR 2.25，95%CI，1.06-4.76，P=0.036）、超重 NAFLD（aHR 1.69，95%CI，0.81-3.51，P=0.153）和瘦型 NAFLD（aHR 2.47，95%CI，1.06-5.73，P=0.037）的死亡率风险增加相关。
在这项针对 NAFLD 患者的全国性队列研究中，肌肉力量而非 BMI 与长期总体死亡率独立相关。测量握力可以作为一种简单、非侵入性的风险分层方法，用于评估 NAFLD 患者的总体死亡率。
Zotero 插件
