OBJECTIVES:Nonalcoholic fatty liver disease (NAFLD) and sarcopenia have a close association with an increased risk of atherosclerotic cardiovascular disease (ASCVD). This study investigated the influence of NAFLD and sarcopenia on ASCVD risk.METHODS:Data from the 2008-2011 Korean National Health and Nutrition Examination Surveys database were analyzed (n = 7,191). The sarcopenia index was calculated using dual-energy X-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cutoffs = 0.882 for men and 0.582 for women). NAFLD was defined as a comprehensive NAFLD score ≥40. Liver fibrosis was assessed using the fibrosis-4 (FIB-4) index. ASCVD risk was evaluated using American College of Cardiology/American Heart Association guidelines. High probability of ASCVD was defined as ASCVD risk >10%.RESULTS:The prevalence rates of NAFLD and sarcopenia were 31.2% (n = 2,241) and 19.5% (n = 1,400), respectively. The quartile-stratified ASCVD risk scores were positively associated with NAFLD and sarcopenia (all P for trend < 0.001). Subjects with both NAFLD and sarcopenia had a higher risk for high probability of ASCVD (odds ratio = 1.83, P = 0.014) compared with controls without NAFLD and sarcopenia. Among subjects with NAFLD, FIB-4-defined significant liver fibrosis and sarcopenia additively raised the risk for high probability of ASCVD (odds ratio = 3.56, P < 0.001) compared with controls without FIB-4-defined significant liver fibrosis or sarcopenia.DISCUSSION:NAFLD and sarcopenia were significantly associated with an increased risk of ASCVD in the general population. In addition, NAFLD with significant liver fibrosis and sarcopenia were significantly associated with an increased risk of ASCVD in subjects with NAFLD.
Bibliographical noteFunding Information:
Guarantor of the article: Yong-ho Lee, MD, PhD, Young Dae Kim, MD, PhD, and Seung Up Kim, MD, PhD. Specific author contributions: Conception and design: E.H., Y.h.L., Y.D.K., and S.U.K. Development of methodology: E.H., Y.h.L., Y.D.K., and S.U.K. Analysis and interpretation of data: E.H., Y.h.L., Y.D.K., and S.U.K. Writing, review, and/or revision of the manuscript: E.H., Y.h.L., Y.D.K., B.K.K., J.Y.P., D.Y.K., S.H.A., B.W.L., E.S.K., B.S.C., K.H.H., H.S.N., J.H.H., and S.U.K. Administrative, technical, or material support: E.H., Y.h.L., Y.D.K., and S.U.K. Study supervision: Y.h.L., Y.D.S., and S.U.K. Financial support: This study was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (2019R1A2C4070136, NRF-2016R1A5A1010764), by Research of Korea Centers for Disease Control and Prevention (2016-ER5103-00, 2016-ER5103-01), and by the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare (HI17C0913), Republic of Korea. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. Potential competing interests: None to report. Writing assistance: The English in this document has been checked by at least 2 professional editors, both native speakers of English (www.editage.co.kr).
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