Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan.
PLoS One. 2024 Mar 26;19(3):e0299313. doi: 10.1371/journal.pone.0299313. eCollection 2024.
Sarcopenia frequently and progressively occurs in patients with chronic liver disease. This study aimed to clarify the relationship between vitamin D levels and muscle mass loss. A total of 166 patients with chronic liver disease were enrolled in this study. Skeletal muscle mass index (SMI) was measured by bioelectrical impedance analysis at baseline and after 1 year. The rate of change in SMI from baseline after 1 year was calculated: ΔSMI (%) = [(1-year SMI - baseline SMI) / baseline SMI] × 100. Muscle mass loss was defined as ΔSMI ≤ -2%. The median 25-hydroxyvitamin D was 15.2 (11.2-19.3) ng/mL. The median SMI were 6.8 (5.9-7.8) kg/m2 at baseline and 6.7 (5.9-7.6) kg/m2 after 1 year. The median ΔSMI was -1.23% (-2.21% to 1.61%). Multivariate analysis identified low 25-hydroxyvitamin D as an independent factor associated with muscle mass loss. The optimal cut-off value of 25-hydroxyvitamin D to predict muscle mass loss was 12.7 ng/mL. Muscle mass loss was found in 56.4% v.s. 18.0% of patients with 25-hydroxyvitamin D < 12.7 vs. ≥ 12.7 ng/mL, respectively (p = 9.01 × 10-7); with the highest incidence in patients with non-alcoholic fatty liver disease (NAFLD). Specifically, patients with NAFLD and 25-hydroxyvitamin D < 12.7 ng/mL had a significantly higher incidence of muscle mass loss than those with ≥ 12.7 ng/mL (p = 1.23 × 10-3). Low vitamin D levels are associated with muscle mass loss after 1 year in patients with chronic liver disease, especially NAFLD.
肌肉减少症在慢性肝病患者中经常且逐渐发生。本研究旨在阐明维生素 D 水平与肌肉质量损失之间的关系。本研究共纳入 166 例慢性肝病患者。基线和 1 年后采用生物电阻抗分析法测量骨骼肌质量指数（SMI）。计算 1 年后 SMI 从基线的变化率：ΔSMI（%）=【（1 年 SMI-基线 SMI）/基线 SMI】×100。肌肉质量损失定义为 ΔSMI≤-2%。中位 25-羟维生素 D 为 15.2（11.2-19.3）ng/ml。基线 SMI 中位数为 6.8（5.9-7.8）kg/m2，1 年后为 6.7（5.9-7.6）kg/m2。中位数ΔSMI为-1.23%（-2.21%~1.61%）。多变量分析确定低 25-羟维生素 D 是与肌肉质量损失相关的独立因素。预测肌肉质量损失的 25-羟维生素 D 最佳截断值为 12.7ng/ml。25-羟维生素 D<12.7ng/ml 组患者肌肉质量损失发生率为 56.4%，25-羟维生素 D≥12.7ng/ml 组为 18.0%，差异有统计学意义（p=9.01×10-7）；非酒精性脂肪性肝病（NAFLD）患者的发生率最高。具体而言，NAFLD 合并 25-羟维生素 D<12.7ng/ml 的患者肌肉质量损失发生率明显高于 25-羟维生素 D≥12.7ng/ml 的患者（p=1.23×10-3）。慢性肝病患者 1 年后维生素 D 水平较低与肌肉质量损失相关，尤其是 NAFLD。
