Risk Stratification for Sarcopenic Obesity in Subjects With Nonalcoholic Fatty Liver Disease

Ho Soo Chun, Minjong Lee, Hye Ah Lee, Sejin Lee, Soyeon Kim, Ye Jun Jung, Chaewon Lee, Hyoeun Kim, Han Ah Lee, Hwi Young Kim, Kwon Yoo, Tae Hun Kim, Sang Hoon Ahn, Seung Up Kim

Research output: Contribution to journalArticlepeer-review


Background & Aims: The impact of the severity of sarcopenic obesity (SO) in nonalcoholic fatty liver disease (NAFLD) on the risk of significant liver fibrosis or cardiovascular disease (CVD) remains unclear. We aimed to identify high-risk subjects with SO for significant liver fibrosis or CVD among subjects with SO and NAFLD. Methods: This multicenter, retrospective study involved 23,889 subjects with NAFLD who underwent a health screening program (2014–2020). Sarcopenia was defined based on gender-specific sarcopenia index cutoff using multi-frequency bioelectric impedance analysis. High-risk subjects with SO were defined as those with significant liver fibrosis by fibrosis-4 index >2.67 or atherosclerotic CVD risk score >20%. Multivariable logistic regression analysis for identifying high-risk subjects with SO was performed in a cross-sectional cohort with SO, and further validation was performed in a longitudinal cohort. Results: SO prevalence was 5.4% (n = 1297 of 23,889). Older age (unstandardized beta [β] = 3.23; P < .001), male (β = 1.66; P = .027), sarcopenia index (β = −6.25; P = .019), and metabolic syndrome (β = 1.75; P < .001) were significant risk factors for high-risk SO. Based on a high-risk SO screening model, high-risk subjects with SO had significantly higher odds of significant liver fibrosis (training: adjusted odds ratio [aOR], 3.72; validation: aOR, 2.38) or CVD (training: aOR, 5.20; validation: aOR, 3.71) than subjects without SO (all P < .001). In subgroup analyses, the cumulative incidence of significant liver fibrosis or CVD development was significantly higher in high-risk subjects with SO than in low-risk subjects with SO in a longitudinal cohort considering all-cause mortality and liver transplantation as competing risks (sub-distribution hazard ratio, 5.37; P < .001). Conclusion: The high-risk screening model may enable the identification of high-risk subjects with SO with NAFLD.

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
Publication statusAccepted/In press - 2023

Bibliographical note

Funding Information:
Funding This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant number: 2017R1D1A1B03031499 , 2022R1I1A1A01068809 , and 2022R1I1A1A01067589 ), the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (grant number: 2020R1C1C1004112 and 2019R1A2C4070136), and Young Investigator Grant from Department of Internal Medicine, Ewha University Medical Center. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2022 AGA Institute

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology


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