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Sarcopenia linked to severe liver fibrosis in NAFLD patients

Researchers found an association between sarcopenia and severity of fibrosis and steatosis among a Western population of patients with nonalcoholic fatty liver disease in a prospective study.

“In a cohort of Western patients with NAFLD and at high prevalence of metabolic disorders and liver damage, sarcopenia is a marker/risk factor for the severity of steatosis and fibrosis, independently of well-known hepatic and metabolic risk factors,” investigators wrote.

The researchers prospectively evaluated the prevalence and risk factors for sarcopenia across the spectrum of liver disease among 225 “relatively healthy” patients with NAFLD (mean age, 48 years; 63% men) recruited from an Italian hospital. Overall, 71% of the patients met criteria for visceral obesity, 45% had impaired fasting glucose or diabetes and 33% had hypertension.

Liver biopsies showed two-thirds of the patients had grade 2-3 steatosis, 81% had NASH and one in three patients had F3-F4 fibrosis. Bioelectrical impedance analysis showed 43.6% of patients had sarcopenia, primarily in older patients and women, with insulin resistance, obesity, altered glucose regulator or diabetes, or higher blood pressure.

Sarcopenia prevalence increased in a linear fashion with fibrosis severity, and compared with F2 or below, the prevalence of severe fibrosis (F3-F4) was increased more than twofold among patients with sarcopenia (48.3% vs. 20.4%; P < .001).

The association between sarcopenia and severe fibrosis held after adjusting for confounders (OR = 2.36; 95% CI, 1.16-4.77), along with older age (>50 years; OR = 6.53; 95% CI, 2.95-14.4), impaired fasting glucose or diabetes (OR = 2.14; 95% CI, 1.05-4.35) and NASH (OR = 13.3; 95% CI, 1.64-108.1).

The investigators also observed a significant association between sarcopenia and NASH (P = .01), steatosis severity (P = .006) and ballooning (P = .01), but multivariable analysis showed only the association with severe steatosis (grade 3) held after adjusting for sex, visceral obesity and impaired fasting glucose or diabetes (OR = 2.02; 95% CI, 1.06-3.83).

Study limitations include the inability to establish causality because of the cross-sectional study design, and the diagnosis of sarcopenia based on skeletal muscle mass index measured by bioelectrical impedance analysis, which is not the gold standard method, the researchers acknowledged.

“Sarcopenia may be corrected by adequate nutritional support,” they concluded. “Further studies are needed to assess the impact of sarcopenia correction on hepatic and metabolic complications in NAFLD patients.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.