Association between muscle strength and advanced fibrosis in non-alcoholic fatty liver disease: a Korean nationwide survey - PubMed (original) (raw)

Association between muscle strength and advanced fibrosis in non-alcoholic fatty liver disease: a Korean nationwide survey

Sunyoung Kang et al. J Cachexia Sarcopenia Muscle. 2020 Oct.

Abstract

Background: We investigated the association between muscle strength and the prevalence of advanced fibrosis among individuals with non-alcoholic fatty liver disease (NAFLD) using a nationwide cross-sectional survey.

Methods: Individuals, 20 to 79 years of age, from the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2014 to 2016 were selected (N = 14 861), with sample weights applied. Muscle strength was quantified as the handgrip strength divided by the body mass index (BMI); low muscle strength (LMS) was defined as the lowest quartile (Q1 ) of the handgrip strength/BMI for our sample population. NAFLD was defined as hepatic steatosis index >36. Advanced fibrosis was defined as a fibrosis-4 index score ≥1.30 (FibrosisFIB4 ).

Results: The mean age of the study population was 45.6 ± 0.2 years, and 42.4% were male. As muscle strength increased, the mean BMI and age decreased accordingly, and the proportions of diabetes, dyslipidaemia, hypertension, and obesity decreased significantly (P < 0.001 for all). In a crude analysis, the LMS was associated with an increased prevalence of NAFLD (odds ratio [OR] 3.62, 95% confidence interval [CI] 3.25-4.03, P < 0.001), which remained significant even after adjustment for age, sex, obesity, insulin resistance, diabetes, hypertension, dyslipidaemia, and high-sensitivity C-reactive protein (OR 1.66, 95% CI 1.28-2.16, P < 0.001). In this logistic regression model, the prevalence of NAFLD decreased by 24% with each quartile increment in muscle strength (OR 0.76, 95% CI 0.68-0.85, P < 0.001). Among individuals with NAFLD (n = 2092), LMS was significantly associated with the presence of advanced fibrosis (FibrosisFIB4 ) independently of age, sex, obesity, diabetes, hypertension, dyslipidaemia, and high-sensitivity C-reactive protein (OR 1.66, 95% CI 1.01-2.49, P = 0.015), which lost its statistical significance after additional adjustment for insulin resistance.

Conclusions: Low muscle strength is independently associated with NAFLD. The significant association between LMS and advanced fibrosis in NAFLD may be mediated through insulin resistance.

Keywords: Hepatic fibrosis; Hepatic steatosis; Insulin resistance; Muscle strength; Sarcopenia.

© 2020 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

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Conflict of interest statement

None declared.

Figures

Figure 1

Figure 1

Flow diagram of participants for the study. Among a total of 23 080 participants in the Korean National Health and Nutrition Examination Surveys (KNHANES) 2014–2016, 13 502 individuals were included in our analysis. Individuals with non‐alcoholic fatty liver disease, defined by hepatic steatosis index, aged 35–65 years (n = 2092), were analysed for advanced fibrosis. HBV, hepatitis B virus; HCV, hepatitis C virus; HGS, handgrip strength.

Figure 2

Figure 2

Prevalence of non‐alcoholic fatty liver disease (NAFLD) according to muscle strength. (A) The prevalence of NAFLD according to muscle strength quartiles in the entire study population. (B) The prevalence of NAFLD in 10 year age strata according to the presence of low muscle strength. *Significantly lower compared with the Q1 (P < 0.05). †Significantly higher compared with the rest of the groups (Q2, Q3, and Q4).

Figure 3

Figure 3

Prevalence of advanced fibrosis according to muscle strength. The prevalence of advanced fibrosis according to muscle strength quartiles. *Significantly lower compared with the Q1 (P < 0.05). BARD, BARD score for non‐alcoholic fatty liver disease fibrosis; FIB‐4, fibrosis‐4 index; low muscle strength was defined as the lowest quartile (Q1) of muscle strength (handgrip strength/body mass index).

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