Prevalence and outcome of sarcopenia in non-alcoholic fatty liver disease

Suprabhat Giri; Prajna Anirvan; Sumaswi Angadi; Ankita Singh; Anurag Lavekar

doi:10.4291/wjgp.v15.i1.91100

Prevalence and outcome of sarcopenia in non-alcoholic fatty liver disease

World J Gastrointest Pathophysiol. 2024 Apr 22;15(1):91100. doi: 10.4291/wjgp.v15.i1.91100.

Authors

Suprabhat Giri¹, Prajna Anirvan², Sumaswi Angadi³, Ankita Singh⁴, Anurag Lavekar⁵

Affiliations

¹ Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India.
² Department of Gastroenterology, Kalinga Gastroenterology Foundation, Cuttack, 753001, Odisha, India.
³ Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad 500082, Telangana, India.
⁴ Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India.
⁵ Department of Gastroenterology, Sagar Hospital, Bengaluru 560041, Karnataka, India. anuraglavekar@gmail.com.

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) includes a spectrum of conditions, progressing from mild steatosis to advanced fibrosis. Sarcopenia, characterized by decreased muscle strength and mass, shares common pathophysiological traits with NAFLD. An association exists between sarcopenia and increased NAFLD prevalence. However, data on the prevalence of sarcopenia in NAFLD and its impact on the outcomes of NAFLD remain inconsistent.

Aim: To analyze the prevalence and outcomes of sarcopenia in patients with NAFLD.

Methods: We conducted a comprehensive search for relevant studies in MEDLINE, Embase, and Scopus from their inception to June 2023. We included studies that focused on patients with NAFLD, reported the prevalence of sarcopenia as the primary outcome, and examined secondary outcomes, such as liver fibrosis and other adverse events. We also used the Newcastle-Ottawa scale for quality assessment.

Results: Of the 29 studies included, the prevalence of sarcopenia in NAFLD varied widely (1.6% to 63.0%), with 20 studies reporting a prevalence of more than 10.0%. Substantial heterogeneity was noted in the measurement modalities for sarcopenia. Sarcopenia was associated with a higher risk of advanced fibrosis (odd ratio: 1.97, 95% confidence interval: 1.44-2.70). Increased odds were consistently observed in fibrosis assessment through biopsy, NAFLD fibrosis score/body mass index, aspartate aminotransferase to alanine aminotransferase ratio, diabetes (BARD) score, and transient elastography, whereas the fibrosis-4 score showed no such association. Sarcopenia in NAFLD was associated with a higher risk of steatohepatitis, insulin resistance, cardiovascular risks, and mortality.

Conclusion: This systematic review highlights the critical need for standardized diagnostic criteria and measurement methods for sarcopenia in NAFLD patients. The variability in study designs and assessment methods for sarcopenia and liver fibrosis may account for the inconsistent findings. This review demonstrates the multidimensional impact of sarcopenia on NAFLD, indicating its importance beyond liver-related events to include cardiovascular risks, mortality, and metabolic complications.

Keywords: Bioelectric impedance analysis; Dual X-ray absorptiometry; Hand grip strength; Hepatic fibrosis; Low muscle mass; Non-alcoholic fatty liver disease; Sarcopenia.