Lincoln Medical Center, New York (NY), USA.
College of Medicine, University of the Philippines, Ermita, Manila, Philippines.
J ASEAN Fed Endocr Soc. 2024;39(1):84-94. doi: 10.15605/jafes.039.01.04. Epub 2023 Oct 27.
Non-alcoholic fatty liver disease (NAFLD) is one of the most prevalent causes of chronic liver disease worldwide which is often seen in patients with metabolic abnormalities such as those with obesity and insulin resistance. On the other hand, sarcopenia is a generalized and progressive skeletal muscle disorder characterized by low muscle strength, low muscle quality, low physical performance, or a combination of the three. Both disease entities share several underlying risk factors and pathophysiologic mechanisms. These include: (1) cardiometabolic overlaps such as insulin resistance, chronic systemic inflammation, decreased vitamin D levels, sex hormone modifications; (2) muscle-related factors such as those mitigated by myostatin signaling, and myokines (i.e., irisin); and (3) liver-dysfunction related factors such as those associated with growth hormone/insulin-like growth factor 1 Axis, hepatokines (i.e., selenoprotein P and leukocyte cell-derived chemotaxin-2), fibroblast growth factors 21 and 19 (FGF21 and FGF19), and hyperammonemia. This narrative review will examine the pathophysiologic overlaps that can explain the links between NAFLD and sarcopenia. Furthermore, this review will explore the emerging roles of nonpharmacologic (e.g., weight reduction, diet, alcohol, and smoking cessation, and physical activity) and pharmacologic management (e.g., roles of β-hydroxy-β-methylbutyrate, branched-chain amino acid supplements, and testosterone therapy) to improve care, intervention sustainability, and acceptability for patients with sarcopenia-associated NAFLD.
非酒精性脂肪性肝病(NAFLD)是全球最常见的慢性肝病病因之一,常发生于代谢异常患者,如肥胖和胰岛素抵抗患者。另一方面,肌肉减少症是一种以肌肉力量、肌肉质量、身体机能降低和/或三者结合为特征的全身性进行性骨骼肌疾病。这两种疾病实体有一些共同的潜在风险因素和病理生理机制。这些因素包括:(1)代谢异常的重叠,如胰岛素抵抗、慢性全身炎症、维生素 D 水平降低、性激素改变;(2)肌肉相关因素,如肌生成素信号和肌肉因子(即鸢尾素)缓解的因素;(3)肝功能相关因素,如与生长激素/胰岛素样生长因子 1 轴、肝因子(即硒蛋白 P 和白细胞细胞衍生趋化因子-2)、成纤维细胞生长因子 21 和 19(FGF21 和 FGF19)和高氨血症相关的因素。本综述将探讨可以解释非酒精性脂肪性肝病和肌肉减少症之间联系的病理生理重叠。此外,本综述将探讨非药物治疗(如减肥、饮食、戒酒和戒烟、体力活动)和药物治疗(如β-羟基-β-甲基丁酸、支链氨基酸补充剂和睾丸激素治疗)的新作用,以改善与肌肉减少症相关的非酒精性脂肪性肝病患者的护理、干预可持续性和可接受性。
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