Open AccessAssociation between muscle strength and advanced fibrosis in non‐alcoholic fatty liver disease: a Korean nationwide survey
Author(s) -
Kang Sunyoung,
Moon Min Kyong,
Kim Won,
Koo Bo Kyung
Publication year - 2020
Publication title -
journal of cachexia, sarcopenia and muscle
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.803
H-Index - 66
eISSN - 2190-6009
pISSN - 2190-5991
DOI - 10.1002/jcsm.12598
Subject(s) - national health and nutrition examination survey , medicine , fatty liver , body mass index , odds ratio , quartile , diabetes mellitus , obesity , gastroenterology , confidence interval , population , insulin resistance , steatosis , endocrinology , disease , environmental health
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 (Q 1 ) 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 (Fibrosis FIB4 ). 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 (Fibrosis FIB4 ) 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.