Lin Yuxi, Liang Zhixing, Liu Xiaofang, Chong Yutian
Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Nutr. 2024 Oct 21;11:1476467. doi: 10.3389/fnut.2024.1476467. eCollection 2024.
The correlation between type 2 diabetes mellitus (T2DM) and the occurrence of liver fibrosis is well-established. However, the longitudinal association between body composition and liver fibrosis progression in patients with T2DM remains incompletely explored.
Total of 390 patients with T2DM underwent body composition assessments, followed by a median duration of 2.13 years. The calculated parameters included body mass index (BMI), fat mass index (FMI), trunk fat mass index (TFMI), appendicular skeletal muscle mass index (ASMI), muscle/fat mass ratio (M/F) and appendicular skeletal muscle mass/trunk fat mass ratio (A/T). Liver fibrosis was evaluated through liver stiffness measurement (LSM). Patients were classified according to BMI and body composition, followed by a comprehensive investigation into the impact of body composition changes on liver fibrosis outcomes.
Among 72 patients with incident advanced liver fibrosis at readmission, ΔBMI, ΔFMI and ΔTFMI increased, while ΔM/F and ΔA/T decreased. Individuals who kept obese had a dramatically elevated hazard of incident advanced liver fibrosis compared to those who kept non-obese, with an adjusted odds ratio of 3.464. When TFMI heightened, the hazard of incident advanced liver fibrosis was 3.601 times higher compared to the decreased group. Additionally, individuals in increased ASMI and A/T groups showed a slight advantage in preventing incident advanced liver fibrosis compared to the stable groups.
Stable obesity was associated with a greater hazard of liver fibrosis advancement, and an increase in TFMI may promote the progression of liver fibrosis. Maintaining a balanced muscle/fat ratio appeared to help prevent the progression.
2型糖尿病（T2DM）与肝纤维化的发生之间的相关性已得到充分证实。然而，T2DM患者身体成分与肝纤维化进展之间的纵向关联仍未得到充分探索。
共有390例T2DM患者接受了身体成分评估，随后进行了为期2.13年的中位数随访。计算的参数包括体重指数（BMI）、脂肪量指数（FMI）、躯干脂肪量指数（TFMI）、四肢骨骼肌量指数（ASMI）、肌肉/脂肪量比（M/F）和四肢骨骼肌量/躯干脂肪量比（A/T）。通过肝脏硬度测量（LSM）评估肝纤维化。根据BMI和身体成分对患者进行分类，随后全面调查身体成分变化对肝纤维化结局的影响。
在72例再入院时发生晚期肝纤维化的患者中，ΔBMI、ΔFMI和ΔTFMI增加，而ΔM/F和ΔA/T降低。与保持非肥胖的患者相比，持续肥胖的个体发生晚期肝纤维化的风险显著升高，调整后的优势比为3.464。当TFMI升高时，发生晚期肝纤维化的风险是降低组的3.601倍。此外，与稳定组相比，ASMI和A/T增加组的个体在预防晚期肝纤维化方面显示出轻微优势。
持续肥胖与肝纤维化进展的更大风险相关，TFMI的增加可能促进肝纤维化的进展。保持肌肉/脂肪比例平衡似乎有助于预防进展。
