Background/Aims: Sarcopenia is associated with nonalcoholic fatty liver disease (NAFLD). This study investigated whether sarcopenia is associated with significant liver fibrosis in subjects with NAFLD.
Methods: Data from the Korean National Health and Nutrition Examination Surveys (KNHANES) 2008-2011 database were analyzed. NALFD was defined by NAFLD liver fat score (NLFS), comprehensive NAFLD score (CNS), or hepatic steatosis index (HSI). Degree of liver fibrosis was assessed by NAFLD fibrosis score (NFS), FIB-4, and Forns index. Significant liver fibrosis was defined as FIB-4 ≥2.67 and the highest quartile values of NFS and Forns index. Sarcopenia index (SI) [SI=total appendicular skeletal muscle mass (kg)/body mass index (BMI, kg/m2)] was calculated using dual-energy x-ray absorptiometry.
Results: Using NLFS, NAFLD was identified in 2,761 (28.5%) of 9,676 subjects. Of subjects with NAFLD, sarcopenia was identified in 337 (12.2%). Sarcopenia was significantly associated with significant liver fibrosis assessed in fibrosis prediction models (all P＜0.05). In subgroups stratified according to BMI and HOMA-IR, a significant association between sarcopenia and significant liver fibrosis by NAFLD fibrosis score (NFS) was consistently present (odds ratio [OR] 22.214.171.124 depending on the subgroup) (all P＜0.05). Multivariate logistic regression analysis demonstrated an independent association between SI and significant liver fibrosis by NFS after adjusting for other confounders (OR 0.52.0.67) (all P<0.01). Other NAFLD (CNS and HSI) and fibrosis prediction models (FIB-4 and Forns index) produced similar results.
Conclusion: Sarcopenia is associated with significant liver fibrosis in subjects with NAFLD, and the association is independent of obesity and insulin resistance.
Key words : Sarcopenia, Liver fibrosis, Nonalcoholic fatty liver disease, Obesity, Insulin resistance