Adverse muscle composition is linked to poor functional performance and metabolic comorbidities in NAFLD

• Background & Aims: Sarcopenia and frailty are recognised as important factors in later stages of liver disease. However, theirrole in non-alcoholic fatty liver disease (NAFLD) is not yet fully understood. In this study we investigate the associations ofMRI-measured adverse muscle composition (AMC: low muscle volume and high muscle fat) with poor function, sarcopenia,and metabolic comorbidity within NAFLD in the large UK Biobank imaging study.Methods: A total of 9,545 participants were included. Liver fat, fat-tissue free muscle volume, and muscle fat infiltration werequantified using a rapid MRI protocol and automated image analysis (AMRA® Researcher). For each participant, a personalisedmuscle volume z-score (sex- and body size-specific) was calculated and combined with muscle fat infiltration for AMC detection. The following outcomes were investigated: functional performance (hand grip strength, walking pace, stairclimbing, falls) and metabolic comorbidities (coronary heart disease, type 2 diabetes). Sarcopenia was detected by combiningMRI thresholds for low muscle quantity and low hand grip strength according to the European working group definition.Results: The prevalence of sarcopenia in NAFLD (1.6%) was significantly lower (p <0.05) compared with controls without fattyliver (3.4%), whereas the prevalence of poor function and metabolic comorbidity was similar or higher. Of the 1,204 participants with NAFLD, 169 (14%) had AMC and showed 1.7–2.4× higher prevalence of poor function (all p <0.05) as well as 2.1×and 3.3× higher prevalence of type 2 diabetes and coronary heart disease (p <0.001), respectively, compared with thosewithout AMC.Conclusions: AMC is a prevalent and highly vulnerable NAFLD phenotype displaying poor function and high prevalence ofmetabolic comorbidity. Sarcopenia guidelines can be strengthened by including cut-offs for muscle fat, enabling AMCdetection.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)

Nyckelord

AMC

adverse muscle composition; CHD

coronary heart disease; Cardiovascular disease; DXA

dual-energy x-ray absorptiometry; Diabetes mellitus; FFMV

fat-tissue free muscle volume; FIB-4

fibrosis-4; Fatty liver; HbA1c

glycated haemoglobin; MFI

muscle fat infiltration; Magnetic resonance imaging; Myosteatosis; NAFLD

non-alcoholic fatty liver disease; NASH

non-alcoholic steatohepatitis; Non-alcoholic steatohepatitis; PDFF

proton density fat fraction; Sarcopenia; Skeletal muscle; T2D

type 2 diabetes; VCG

virtual control group

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