Non-alcoholic Fatty Liver Disease and Sarcopenia Additively Increase Mortality: a Korean Nationwide Survey

Overview

Journal J Cachexia Sarcopenia Muscle

Date 2021 Jun 3

PMID 34080327

Citations 24

Authors

Joon Ho Moon

Bo Kyung Koo

Won Kim

Affiliations

Soon will be listed here.

Abstract

Background: Sarcopenia is an independent risk factor not only for advanced-stage non-alcoholic fatty liver disease (NAFLD) but also for mortality. We investigated the association of sarcopenia and/or NAFLD with mortality among the Korean general population.

Methods: Individuals aged 35-75 years without any history of cancer, ischaemic heart disease, ischaemic stroke, or secondary causes of chronic liver disease were selected from the Korean National Health and Nutrition Examination Surveys from 2008 to 2015. Their mortality data until December 2018 were retrieved from the National Death Registry. NAFLD and sarcopenia were defined by hepatic steatosis index and appendicular skeletal muscle mass divided by body mass index (BMI), respectively.

Results: A total of 28 060 subjects were analysed [mean age, 50.6 (standard error, 0.1) years, 48.2 (0.3) % men]; the median follow-up duration was of 6.8 (interquartile range, 4.8, 8.4) years. NAFLD predicted mortality after adjustment for age, sex, BMI, hypertension, dyslipidaemia, and smoking (HR 1.32, 95% CI 1.03-1.70), but this prediction lost its statistical significance after additional adjustment for diabetes mellitus. In contrast, NAFLD with advanced fibrosis independently increased the risk of mortality after adjustment for all covariates (HR 1.68, 95% CI 1.02-2.79). Stratified analysis revealed that NAFLD and sarcopenia additively increased the risk of mortality as an ordinal scale (HR 1.46, 95% CI 1.18-1.81, P for trend = 0.001). The coexistence of NAFLD and sarcopenia increased the risk of mortality by almost twice as much, even after adjustment for advanced fibrosis (HR 2.18, 95% CI 1.38-3.44).

Conclusions: Concurrent NAFLD and sarcopenia conferred a two-fold higher risk of mortality. The observation that NAFLD and sarcopenia additively increase mortality suggests that risk stratification would be helpful in predicting mortality among those with metabolic derangement.

Citing Articles

Impact of steatotic liver disease subtypes, sarcopenia, and fibrosis on all-cause and cause-specific mortality: a 15.7-year cohort study.

Liang Y, Ye X, Pan M, Chen Y, Yuan Y, Luo L BMC Gastroenterol. 2025; 25(1):75.

PMID: 39934679 PMC: 11818238. DOI: 10.1186/s12876-025-03661-0.

Institutional Nomogram for Estimating Risk of Metabolic Associated Fatty Liver Disease (MAFLD).

Lv T, Tian J, Sun Y, Zhang Y, Qi F, Xiang L Diabetes Metab Syndr Obes. 2024; 17:3735-3752.

PMID: 39403553 PMC: 11472740. DOI: 10.2147/DMSO.S469677.

Exercise and nutrition benefit skeletal muscle: From influence factor and intervention strategy to molecular mechanism.

Feng L, Li B, Yong S, Wu X, Tian Z Sports Med Health Sci. 2024; 6(4):302-314.

PMID: 39309454 PMC: 11411340. DOI: 10.1016/j.smhs.2024.02.004.

Advances in sarcopenia: mechanisms, therapeutic targets, and intervention strategies.

Zheng Y, Feng J, Yu Y, Ling M, Wang X Arch Pharm Res. 2024; 47(4):301-324.

PMID: 38592582 DOI: 10.1007/s12272-024-01493-2.

ADAR2 deficiency ameliorates non-alcoholic fatty liver disease and muscle atrophy through modulating serum amyloid A1.

Kung M, Yang T, Lin C, Ho J, Hung T, Chang C J Cachexia Sarcopenia Muscle. 2024; 15(3):949-962.

PMID: 38533529 PMC: 11154747. DOI: 10.1002/jcsm.13460.

References

von Haehling S, Morley J, Coats A, Anker S . Ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2019. J Cachexia Sarcopenia Muscle. 2019; 10(5):1143-1145. PMC: 6818444. DOI: 10.1002/jcsm.12501. View

Younossi Z, Anstee Q, Marietti M, Hardy T, Henry L, Eslam M . Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2017; 15(1):11-20. DOI: 10.1038/nrgastro.2017.109. View

Studenski S, Peters K, Alley D, Cawthon P, McLean R, Harris T . The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci. 2014; 69(5):547-58. PMC: 3991146. DOI: 10.1093/gerona/glu010. View

Romero-Corral A, Montori V, Somers V, Korinek J, Thomas R, Allison T . Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006; 368(9536):666-78. DOI: 10.1016/S0140-6736(06)69251-9. View

Lazo M, Hernaez R, Bonekamp S, Kamel I, Brancati F, Guallar E . Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 2011; 343:d6891. PMC: 3220620. DOI: 10.1136/bmj.d6891. View

Yazar T, Olgun Yazar H . Prevalance of sarcopenia according to decade. Clin Nutr ESPEN. 2019; 29:137-141. DOI: 10.1016/j.clnesp.2018.11.005. View

Bano G, Trevisan C, Carraro S, Solmi M, Luchini C, Stubbs B . Inflammation and sarcopenia: A systematic review and meta-analysis. Maturitas. 2017; 96:10-15. DOI: 10.1016/j.maturitas.2016.11.006. View

Grundy S, Cleeman J, Daniels S, Donato K, Eckel R, Franklin B . Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112(17):2735-52. DOI: 10.1161/CIRCULATIONAHA.105.169404. View

Chen F, Esmaili S, Rogers G, Bugianesi E, Petta S, Marchesini G . Lean NAFLD: A Distinct Entity Shaped by Differential Metabolic Adaptation. Hepatology. 2019; 71(4):1213-1227. DOI: 10.1002/hep.30908. View

10.

Kweon S, Kim Y, Jang M, Kim Y, Kim K, Choi S . Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43(1):69-77. PMC: 3937975. DOI: 10.1093/ije/dyt228. View

11.

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

12.

. 2. Classification and Diagnosis of Diabetes: . Diabetes Care. 2019; 43(Suppl 1):S14-S31. DOI: 10.2337/dc20-S002. View

13.

Cho Y, Lim Y, Yun J, Yoon H, Park M . Sex- and age-specific effects of energy intake and physical activity on sarcopenia. Sci Rep. 2020; 10(1):9822. PMC: 7300112. DOI: 10.1038/s41598-020-66249-6. View

14.

Seo M, Lee W, Kim S, Kang J, Kang J, Kim K . 2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea. J Obes Metab Syndr. 2019; 28(1):40-45. PMC: 6484940. DOI: 10.7570/jomes.2019.28.1.40. View

15.

Dalle S, Rossmeislova L, Koppo K . The Role of Inflammation in Age-Related Sarcopenia. Front Physiol. 2018; 8:1045. PMC: 5733049. DOI: 10.3389/fphys.2017.01045. View

16.

McPherson S, Stewart S, Henderson E, Burt A, Day C . Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010; 59(9):1265-9. DOI: 10.1136/gut.2010.216077. View

17.

Petersen M, Shulman G . Mechanisms of Insulin Action and Insulin Resistance. Physiol Rev. 2018; 98(4):2133-2223. PMC: 6170977. DOI: 10.1152/physrev.00063.2017. View

18.

Williams C, Stengel J, Asike M, Torres D, Shaw J, Contreras M . Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2010; 140(1):124-31. DOI: 10.1053/j.gastro.2010.09.038. View

19.

Zhang H, Zhang X, Ma Z, Pan L, Chen Z, Han H . Irisin is inversely associated with intrahepatic triglyceride contents in obese adults. J Hepatol. 2013; 59(3):557-62. DOI: 10.1016/j.jhep.2013.04.030. View

20.

Welch N, Dasarathy J, Runkana A, Penumatsa R, Bellar A, Reen J . Continued muscle loss increases mortality in cirrhosis: Impact of aetiology of liver disease. Liver Int. 2020; 40(5):1178-1188. PMC: 7195232. DOI: 10.1111/liv.14358. View