Sarcopaenia is associated with NAFLD independently of obesity and insulin resistance: Nationwide surveys (KNHANES 2008-2011)

Yong Ho Lee, Kyu Sik Jung, Seung Up Kim, Hye Jin Yoon, Yu Jung Yun, Byung Wan Lee, Eun Seok Kang, Kwang Hyub Han, Hyun Chul Lee, Bong Soo Cha

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210 Citations (Scopus)


Background & Aims: Although sarcopaenia is associated with obesity-related comorbidities, its influence on non-alcoholic fatty liver disease (NAFLD) or steatohepatitis has not been fully determined. We aimed to investigate the direct relationship between sarcopaenia and NAFLD or steatohepatitis in the general population. Methods:We conducted a cross-sectional study using nationally representative samples of 15,132 subjects from the Korea National Health and Nutrition Examination Surveys 2008-2011. Subjects were defined as having NAFLD when they had higher scores from previously validated NAFLD prediction models such as the hepatic steatosis index, comprehensive NAFLD score and NAFLD liver fat score. BARD and FIB-4 scores were used to define advanced fibrosis in subjects with NAFLD. The skeletal muscle index (SMI) [SMI(%) = total appendicular skeletal muscle mass (kg)/weight (kg)- 100] measured by dual-energy X-ray absorptiometry was used to diagnose sarcopaenia with cut points of 32.2% for men and 25.5% for women. Results: SMI was inversely correlated with all NAFLD predicting scores (Ps <0.001). After stratification, sarcopaenic subjects had an increased risk of NAFLD regardless of obesity (odds ratios [ORs] = 1.55 to 3.02, depending on models; all Ps <0.001) or metabolic syndrome (ORs = 1.63 to 4.00, all Ps <0.001). Multiple logistic regression analysis also demonstrated this independent association between sarcopaenia and NAFLD after adjusting for confounding factors related to obesity or insulin resistance (ORs = 1.18 to 1.22, all Ps <0.001). Furthermore, among the NAFLD population, subjects with lower SMIs were likely to have advanced fibrosis compared with non-sarcopaenic individuals (BARD and FIB-4: ORs = 1.83 and 1.69, respectively; both Ps <0.001). Compared with non-exercised subjects, individuals who exercised regularly had a lower risk of NAFLD (p <0.001), particularly among obese people with well-preserved muscle mass. Conclusions: Sarcopaenia is associated with increased risks of NAFLD and advanced fibrosis, independent of obesity or metabolic control.

Original languageEnglish
Pages (from-to)486-493
Number of pages8
JournalJournal of Hepatology
Issue number2
Publication statusPublished - 2015

Bibliographical note

Funding Information:
This study was supported by the grant of the Brain Korea 21 PLUS Project for Medical Science , Yonsei University and the Korean Health Technology R&D Project , Ministry of Health & Welfare , Republic of Korea (No. HI14C2476 ). The authors are very grateful to officers who conducted KNHANES.

Publisher Copyright:
© 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Hepatology


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