Kim Myung Jin, Cho Yun Kyung, Kim Eun Hee, Lee Min Jung, Lee Woo Je, Kim Hong-Kyu, Jung Chang Hee
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Asan Diabetes Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Cachexia Sarcopenia Muscle. 2024 Oct;15(5):1942-1952. doi: 10.1002/jcsm.13543. Epub 2024 Jul 16.
In 2023, the concept of metabolic dysfunction-associated steatotic liver disease (MASLD) was introduced as an alternative to non-alcoholic fatty liver disease (NAFLD). We aimed to assess the quantity and quality of skeletal muscle using each of these diagnostic classifications.
This cross-sectional study included 18 154 participants (11 551 [63.6%] men and 6603 [36.4%] women, mean age 53.0 ± 8.8). The participants were classified into four categories: neither steatotic liver disease (SLD), NAFLD only, MASLD only or both SLDs. An appendicular skeletal muscle mass adjusted for body mass index of <0.789 for men and <0.512 for women was defined as sarcopenia. The total abdominal muscle area (TAMA) at the L3 vertebral level was segmented into normal-attenuation muscle area (NAMA), low-attenuation muscle area and intermuscular/intramuscular adipose tissue. Myosteatosis was defined by a T-score < -1.0 of the NAMA/TAMA index, which was calculated by dividing the NAMA by the TAMA and multiplying by 100.
Using subjects with neither SLD as a reference, the multivariable-adjusted odds ratios (ORs) for sarcopenia were significantly increased in those with MASLD, with adjusted ORs (95% confidence interval [CI]) of 2.62 (1.94-3.54) in the MASLD-only group and 2.33 (1.92-2.82) in the both SLDs group, while the association was insignificant in those with NAFLD only (adjusted OR [95% CI]: 2.16 [0.67-6.94]). The OR for myosteatosis was also elevated in the MASLD groups, with an OR (95% CI) of 1.75 (1.52-2.02) in subjects with MASLD only and 1.70 (1.57-1.84) in those with both SLDs, while it was slightly decreased in subjects with NAFLD only (0.52 [0.29-0.95]).
Employing the MASLD concept rather than that of the NAFLD proved to be more effective in distinguishing individuals with reduced muscle mass and compromised muscle quality.
2023年，代谢功能障碍相关脂肪性肝病（MASLD）的概念被引入，作为非酒精性脂肪性肝病（NAFLD）的替代术语。我们旨在使用这些诊断分类中的每一种来评估骨骼肌的数量和质量。
这项横断面研究纳入了18154名参与者（男性11551名[63.6%]，女性6603名[36.4%]，平均年龄53.0±8.8岁）。参与者被分为四类：既无脂肪性肝病（SLD）、仅患有NAFLD、仅患有MASLD或同时患有两种SLD。男性体重指数调整后的四肢骨骼肌质量<0.789，女性<0.512被定义为肌肉减少症。L3椎体水平的总腹肌面积（TAMA）被分割为正常衰减肌肉面积（NAMA）、低衰减肌肉面积和肌间/肌内脂肪组织。肌脂肪变性由NAMA/TAMA指数的T值<-1.0定义，该指数通过将NAMA除以TAMA并乘以100计算得出。
以既无SLD的受试者作为对照，MASLD患者中肌肉减少症的多变量调整优势比（OR）显著增加，仅患有MASLD组的调整后OR（95%置信区间[CI]）为2.62（1.94-3.54），两种SLD都有的组为2.33（1.92-2.82），而仅患有NAFLD的患者中这种关联不显著（调整后OR[95%CI]：2.16[0.67-6.94]）。MASLD组中肌脂肪变性的OR也升高，仅患有MASLD的受试者的OR（95%CI）为1.75（1.52-2.02），两种SLD都有的受试者为1.70（1.57-1.84），而仅患有NAFLD的受试者中该OR略有下降（0.52[0.29-0.95]）。
事实证明，采用MASLD概念而非NAFLD概念在区分肌肉量减少和肌肉质量受损的个体方面更有效。
