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Sarcopenia associated with NASH, fibrosis in patients with NAFLD

For patients with nonalcoholic fatty liver disease, sarcopenia was associated with nonalcoholic steatohepatitis and significant fibrosis, according to recent findings published in the Journal of Hepatology.

“It is acknowledged that a progressive decrease in muscle mass and an increase in fat mass, particularly that of the visceral component, are common body compositional changes associated with aging,” Won Kim, MD, PhD, associate professor in the division of gastroenterology and hepatology at the Seoul National University College of Medicine, told Healio.com/Hepatology. “In the elderly population, sarcopenia has been closely related to many clinical consequences, including metabolic impairment, increased cardiovascular risk, and mortality.”

Won Kim

Low skeletal muscle mass can reduce insulin-mediated glucose disposal, the researchers wrote. Further, recent research has shown that sarcopenia is associated with NAFLD and advanced fibrosis.

To assess whether sarcopenia was also associated with NASH, Kim and colleagues measured the appendicular skeletal muscle mass (ASM) of 309 patients with biopsy-proven NAFLD. The researchers defined sarcopenia as ASM divided by body weight (ASM%) that is at least two standard deviations below the mean for healthy young adults.

In the cohort, those who had sarcopenia included 8.7% of those without NAFLD, 17.9% of those with NAFLD and 35% of those with NASH (P < .001). ASM% was inversely correlated with fibrosis severity (P < .001), and the prevalence of fibrosis of at least stage 2 was higher in patients with sarcopenia compared with those without (45.7% vs. 24.7%; P < .001). Sarcopenia was associated with NAFLD in a crude analysis (OR = 3.82; 95% CI, 1.58-9.25). However, sarcopenia was not associated with NAFLD after adjusting for BMI, diabetes and hypertension. Among patients with NAFLD, sarcopenia was associated with NASH, after adjusting for age, sex, BMI, hypertension, diabetes and smoking status (OR = 2.28; 95% CI, 1.21-4.3). Further, sarcopenia was associated with significant fibrosis, after adjusting for BMI and insulin resistance (OR = 2.05; 95% CI, 1.01-4.16).

The researchers concluded that ASM might be a new central strategy for the prevention and management of NASH and significant fibrosis.

“Because sarcopenia is closely interconnected with diabetes and obesity, our study sheds light on the impact of sarcopenia on significant fibrosis and NASH independently of diabetes and obesity,” Kim said. “Given that people are living longer in most developed nations, it is of paramount importance to manage age-related sarcopenia because we may expect an increase in the prevalence of NASH as well as of diabetes accompanying increased aging.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.