Sarcopenia Is Independently Associated with the Degree of Liver Fibrosis in Patients with Type 2 Diabetes Mellitus - PubMed (original) (raw)

Sarcopenia Is Independently Associated with the Degree of Liver Fibrosis in Patients with Type 2 Diabetes Mellitus

Min Je Sung et al. Gut Liver. 2020.

Abstract

Background/aims: Sarcopenia is associated with liver fibrosis in patients with nonalcoholic fatty liver disease and chronic hepatitis B. We investigated the association between sarcopenia and hepatic fibrotic burden in patients with type 2 diabetes mellitus (T2DM).

Methods: Patients with T2DM who had received a comprehensive medical health checkup were recruited. Muscle mass was assessed using computed tomography. Fibrotic burden was assessed using the fibrosis-4 index (FIB-4). The study population was divided by quartile stratification of the lumbar skeletal muscle index (LSMI).

Results: Among 309 patients with T2DM, 75 (24.3%) had sarcopenia. These patients were significantly older and had higher FIB-4, whereas they had significantly lower body mass index (BMI) and LSMI than patients without sarcopenia (all p<0.05). The LSMI showed a significant negative correlation with the FIB-4 when analyzed in terms of quartile stratification (p=0.003). Multivariate analysis showed that female sex and higher BMI were independently associated with a reduced risk of sarcopenia (odds ratio [OR], 0.388; 95% confidence interval [CI], 0.199 to 0.755 and OR, 0.704; 95% CI, 0.618 to 0.801; all p<0.05), whereas a higher FIB- 4 was independently associated with an increased risk of sarcopenia (OR, 1.817; 95% CI, 1.180 to 2.797; p=0.007). Among patients with a BMI <25 kg/m2 (n=165), those with sarcopenia (n=54, 32.7%) had a significantly higher FIB-4 than those without (n=111, 67.3%; 1.66 vs 1.38, p=0.004).

Conclusions: Sarcopenia is independently associated with fibrotic burden in patients with T2DM. Further studies should investigate whether the improvement of sarcopenia can ameliorate liver fibrosis in patients with T2DM.

Keywords: Diabetes mellitus; Fibrosis-4 index; Liver fibrosis; Muscular atrophy; Sarcopenia.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1

Fig. 1

Flow of study population selection. CT, computed tomography; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus.

Fig. 2

Fig. 2

Association between muscle mass and fibrotic burden using the fibrosis-4 (FIB-4) index (A) and NAFLD fibrosis score (NFS) (B). The muscle mass showed a strong negative association with fibrotic burden using the FIB-4 index (p=0.023). NAFLD, nonalcoholic fatty liver disease.

Fig. 3

Fig. 3

Association between muscle mass and fibrotic burden by quartile stratification analysis when fibrotic burden was assessed using fibrosis-4 (FIB-4) index. (A) Muscle mass showed a strong negative association with fibrotic burden (p=0.003). (B) Sarcopenia patients in the lowest quartile of muscle mass showed a strong association with fibrotic burden, with FIB-4 ≥1.45 (p=0.019). LSMI, lumbar skeletal muscle index.

Fig. 4

Fig. 4

Fibrotic burden was assessed using the fibrosis-4 (FIB-4) index and NAFLD fibrosis score (NFS) according to sarcopenic status after stratification according to sex and BMI (<25 and ≥25 kg/m2). When analyzed using FIB-4, sarcopenic subjects had a significantly higher fibrotic burden than nonsarcopenic subjects in the subgroups with female sex (A) and BMI <25 kg/m2 (B) (all p<0.05). When analyzed using NFS, sarcopenic subjects had a significantly higher fibrotic burden than nonsarcopenic subjects in subgroups of male sex (C) and a BMI <25 kg/m2 (D) (all p<0.05). NAFLD, nonalcoholic fatty liver disease; BMI, body mass index.

References

    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–423. doi: 10.1093/ageing/afq034. - DOI - PMC - PubMed
    1. Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15:95–101. doi: 10.1016/j.jamda.2013.11.025. - DOI - PubMed
    1. Itoh S, Shirabe K, Yoshizumi T, et al. Skeletal muscle mass assessed by computed tomography correlates to muscle strength and physical performance at a liver-related hospital experience. Hepatol Res. 2016;46:292–297. doi: 10.1111/hepr.12537. - DOI - PubMed
    1. The Lancet Diabetes Endocrinology, author. Sarcopenia: a fate worth challenging. Lancet Diabetes Endocrinol. 2014;2:183. doi: 10.1016/S2213-8587(14)70055-5. - DOI - PubMed
    1. Kim TN, Park MS, Yang SJ, et al. Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: the Korean Sarcopenic Obesity Study (KSOS) Diabetes Care. 2010;33:1497–1499. doi: 10.2337/dc09-2310. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources