Zhang Fan, Liu Longgen, Li Wenjian
Department of Endocrinology, Changzhou Third People's Hospital, Changzhou, 213001, China.
Department of Clinical Nutrition, Changzhou Third People's Hospital, Changzhou, 213001, China.
Nutr J. 2025 Jan 14;24(1):6. doi: 10.1186/s12937-025-01081-0.
The objective of this study was to investigate the association between sarcopenia and liver fibrosis in patients aged 18-59 years with metabolic dysfunction-associated steatotic liver disease (MASLD) and to assess the potential of sarcopenia as a risk factor for the progression of liver fibrosis.
The study included 821 patients with MASLD in the US cohort and 3,405 patients with MASLD in the Chinese cohort. Liver controlled attenuation parameters (CAP) and liver stiffness measurements (LSM) were assessed by vibration-controlled transient elastography (VCTE) to evaluate the extent of hepatic steatosis and fibrosis. Sarcopenia was assessed by measuring appendicular skeletal muscle mass (ASM) and calculating ASMI. To analyze the relationship between sarcopenia, ASMI, and liver fibrosis, logistic regression models, multivariate-adjusted models, and restricted cubic spline (RCS) models were employed, with stratification and interaction analyses.
The results demonstrated that patients with sarcopenia exhibited a markedly elevated risk of significant liver fibrosis, advanced liver fibrosis, and cirrhosis compared to those without sarcopenia in both cohorts. After adjusting for confounding variables, sarcopenia was identified as an independent risk factor for the progression of liver fibrosis in patients with MASLD. A significant negative correlation was observed between ASMI and the severity of liver fibrosis, with a progressive reduction in the risk of liver fibrosis associated with increasing ASMI. Additionally, a non-linear feature was evident in some liver fibrosis indicators. Subgroup analysis further corroborated the finding that the harmful effect of sarcopenia on liver fibrosis was consistent across all identified subgroups.
Sarcopenia may be associated with the progression of liver fibrosis in patients with MASLD. Monitoring ASMI may assist in identifying individuals at an elevated risk of liver fibrosis in MASLD patients.
本研究旨在调查18 - 59岁代谢功能障碍相关脂肪性肝病（MASLD）患者中肌肉减少症与肝纤维化之间的关联，并评估肌肉减少症作为肝纤维化进展风险因素的可能性。
该研究纳入了美国队列中的821例MASLD患者和中国队列中的3405例MASLD患者。通过振动控制瞬时弹性成像（VCTE）评估肝脏控制衰减参数（CAP）和肝脏硬度测量值（LSM），以评估肝脂肪变性和纤维化的程度。通过测量四肢骨骼肌质量（ASM）并计算ASMI来评估肌肉减少症。为了分析肌肉减少症、ASMI与肝纤维化之间的关系，采用了逻辑回归模型、多变量调整模型和受限立方样条（RCS）模型，并进行了分层和交互分析。
结果表明，在两个队列中，与无肌肉减少症的患者相比，有肌肉减少症的患者出现显著肝纤维化、进展性肝纤维化和肝硬化的风险明显升高。在调整混杂变量后，肌肉减少症被确定为MASLD患者肝纤维化进展的独立风险因素。观察到ASMI与肝纤维化严重程度之间存在显著负相关，随着ASMI增加，肝纤维化风险逐渐降低。此外，一些肝纤维化指标呈现非线性特征。亚组分析进一步证实了这一发现，即肌肉减少症对肝纤维化的有害影响在所有确定的亚组中都是一致的。
肌肉减少症可能与MASLD患者的肝纤维化进展有关。监测ASMI可能有助于识别MASLD患者中肝纤维化风险升高的个体。
