Department of Gastroenterology and Hepatology, Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea.
Department of Gastroenterology and Hepatology, Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, South Korea.
J Cachexia Sarcopenia Muscle. 2022 Dec;13(6):2953-2960. doi: 10.1002/jcsm.13099. Epub 2022 Oct 12.
BACKGROUND: Metabolic (dysfunction)-associated fatty liver disease (MAFLD) emphasizes the metabolic dysfunction in nonalcoholic fatty liver disease (NAFLD). Although the relationship between low muscle mass and NAFLD has been suggested, the effect of MAFLD on low muscle mass is yet to be investigated. In this study, we examined the relationship between MAFLD and low muscle mass in an asymptomatic Korean population. METHODS: Examinees who underwent FibroScan® and bioelectrical impedance analyses on the same day during the period of June 2017 to December 2019 were included. Hepatic steatosis was diagnosed using controlled attenuation parameter (CAP) with two cut-off values of 248 and 294 dB/m. Low muscle mass was defined based on appendicular skeletal muscle mass/body weight (wt) or body mass index (BMI) ratios of two standard deviations below the sex-specific mean for healthy young adults. Subjects were divided into four subgroups: diabetic MAFLD (presence of diabetes mellitus [DM]), metabolic dysfunction (MD) MAFLD (≥2 metabolic abnormalities without DM), overweight MAFLD (overweight/obese without DM and <2 metabolic abnormalities) and no MAFLD. RESULTS: Among all of the 6414 subjects (mean 53.9 years of age; 85.4% male), the prevalence of MAFLD was 49.9% and 22.7% for CAP cut-off values of 248 and 294 dB/m, respectively. In the multivariate analysis, MAFLD was associated with an increased risk of both low muscle mass_wt (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.38-2.35, P < 0.001) and low muscle mass_BMI (OR 1.31, 95% CI 1.01-1.70, P = 0.042). The risk of low muscle mass_wt and low muscle mass_BMI increased the most in the diabetic MAFLD subgroup compared with the no-MAFLD group (OR 2.11, 95% CI 1.51-2.96, P < 0.001 and OR 1.51, 95% CI 1.08-2.13, P = 0.017). There was an increased risk of low muscle mass_wt in the MD MAFLD subgroup (OR 1.73, 95% CI 1.31-2.28, P < 0.001). Comparable results were observed when the CAP cut-off value of 294 dB/m was applied. CONCLUSIONS: The presence of MAFLD is significantly associated with increased risk of low muscle mass with varying risks according to the MAFLD subgroups. Clinicians should be aware of the differentiated risk of low muscle mass across the subgroups of MAFLD.
背景：代谢（功能障碍）相关脂肪性肝病（MAFLD）强调了非酒精性脂肪性肝病（NAFLD）中的代谢功能障碍。虽然已经提出了低肌肉量与 NAFLD 之间的关系，但 MAFLD 对低肌肉量的影响仍有待研究。在这项研究中，我们在一个无症状的韩国人群中检查了 MAFLD 与低肌肉量之间的关系。
方法：纳入了 2017 年 6 月至 2019 年 12 月期间同一天接受 FibroScan®和生物电阻抗分析的受检者。使用控制衰减参数（CAP）诊断肝脂肪变性，其两个截断值分别为 248 和 294 dB/m。低肌肉量定义为四肢骨骼肌量/体重（wt）或身体质量指数（BMI）比健康年轻成年人的两个标准差低。受试者分为四组：糖尿病 MAFLD（存在糖尿病[DM]）、代谢功能障碍（MD）MAFLD（≥2 种代谢异常而无 DM）、超重 MAFLD（超重/肥胖而无 DM 和 <2 种代谢异常）和无 MAFLD。
结果：在所有 6414 名受试者（平均年龄 53.9 岁；85.4%为男性）中，MAFLD 的患病率分别为 CAP 截断值为 248 和 294 dB/m 时的 49.9%和 22.7%。在多变量分析中，MAFLD 与低肌肉量_wt（比值比[OR]1.80，95%置信区间[CI]1.38-2.35，P<0.001）和低肌肉量_BMI（OR 1.31，95%CI 1.01-1.70，P=0.042）的风险增加相关。与无 MAFLD 组相比，糖尿病 MAFLD 亚组的低肌肉量_wt 和低肌肉量_BMI 风险增加最多（OR 2.11，95%CI 1.51-2.96，P<0.001 和 OR 1.51，95%CI 1.08-2.13，P=0.017）。MD MAFLD 亚组的低肌肉量_wt 风险增加（OR 1.73，95%CI 1.31-2.28，P<0.001）。当应用 CAP 截断值 294 dB/m 时，观察到类似的结果。
结论：MAFLD 的存在与低肌肉量的风险显著增加相关，不同的 MAFLD 亚组风险不同。临床医生应注意 MAFLD 亚组中低肌肉量的差异化风险。
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