Contribution of sarcopenia and physical inactivity to mortality in people with non-alcoholic fatty liver disease

Pegah Golabi; Lynn Gerber; James M Paik; Rati Deshpande; Leyla de Avila; Zobair M Younossi

doi:10.1016/j.jhepr.2020.100171

Contribution of sarcopenia and physical inactivity to mortality in people with non-alcoholic fatty liver disease

JHEP Rep. 2020 Aug 15;2(6):100171. doi: 10.1016/j.jhepr.2020.100171. eCollection 2020 Dec.

Authors

Pegah Golabi¹, Lynn Gerber^{1

2}, James M Paik¹, Rati Deshpande¹, Leyla de Avila¹, Zobair M Younossi^{1

2}

Affiliations

¹ Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
² Center for Liver Disease, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.

Abstract

Background & aims: Physical inactivity and sedentary lifestyle have contributed to the epidemic of obesity and non-alcoholic fatty liver disease (NAFLD). We assessed the association between physical activity, NAFLD, and sarcopenia, and their contributions to mortality.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 with Linked Mortality file (through 2015) was utilised. NAFLD was determined by the US Fatty Liver Index in the absence of secondary causes of liver disease. Sarcopenia was defined using appendicular lean mass divided by body mass index by the Foundation for the National Institutes of Health criteria. Activity level was determined using standard self-reports. Publicly available imputed dual-energy X-ray absorptiometry data sets were used.

Results: Of 4,611 NHANES participants (48.2% males; 72.5% White; mean age 45.9 years), NAFLD was present in 1,351 (29.3%), of whom 17.7% had sarcopenia. Of the NAFLD group, 46.3% was inactive, whilst intermediate and ideal physical activity rates were observed in 14.2% and 39.5%, respectively. Sarcopenia was significantly and inversely related to higher physical activity level, both amongst NAFLD (odds ratio [OR] = 0.45 [95% CI 0.30-0.69]) and non-NAFLD (OR = 0.51 [0.35-0.75]) groups. During a median follow-up of 13.5 years, a total of 586 subjects died, of whom 251 had NAFLD. Amongst those who died with NAFLD, 33.0% had sarcopenia and 54.3% were inactive. Compared with NAFLD without sarcopenia, NAFLD with sarcopenia was associated with a higher risk of all-cause (hazard ratio [HR] = 1.78 [1.16-2.73]), cardiac-specific (HR = 3.19 [1.17-8.74]), and cancer-specific mortality (HR = 2.12 [1.08-4.15]).

Conclusions: Inactivity is associated with presence of sarcopenia, whilst sarcopenia is associated with increased mortality amongst NAFLD patients. Sarcopenia should be a part of clinical assessment of patients with NAFLD. Treatment of NAFLD should include optimal management of sarcopenia.

Lay summary: Nonalcoholic fatty liver disease (NAFLD) and sarcopenia have similar pathophysiological profiles. Our data show that sarcopenia is associated with inactivity in subjects with NAFLD. The presence of sarcopenia in patients with NAFLD poses increased risk for all-cause and cardiac-specific mortality.

Keywords: ALM, appendicular lean mass; BMI, body mass index; CV, cardiovascular; CVD, cardiovascular disease; DXA, dual-energy X-ray absorptiometry; EWGSOP2, Revised European Working Group on Sarcopenia in Older People; FNIH, Foundation for the National Institutes of Health; GGT, gamma glutamyltransferase; HL, hyperlipidaemia; HR, hazard ratio; HTN, hypertension; MS, metabolic syndrome; NAFLD, non-alcoholic fatty liver disease; NFS, NAFLD fibrosis score; NHANES, National Health and Nutrition Examination Survey; Non-alcoholic fatty liver disease; Physical activity; Sarcopenia; T2DM, type 2 diabetes mellitus; US FLI, Fatty Liver Index for the multi-ethnic US population.