Restoring skeletal muscle mass as an independent determinant of liver fat deposition improvement in MAFLD

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Abstract

Aims

Cross-sectional studies have demonstrated the association of skeletal muscle mass with metabolic-associated fatty liver disease (MAFLD), while longitudinal data are scarce. We aimed to explore the impact of changes in relative skeletal muscle mass on the MAFLD treatment response.

Methods

MAFLD patients undergoing magnetic resonance imaging-based proton density fat fraction for liver fat content (LFC) assessments and bioelectrical impedance analysis before and after treatment (orlistat, meal replacement, lifestyle modifications) were enrolled. Appendicular muscle mass (ASM) was adjusted by weight (ASM/W).

Results

Overall, 256 participants were recruited and divided into two groups: with an ASM/W increase ( n=166) and without an ASM/W increase ( n=90). There was a great reduction in LFC in the group with an ASM/W increase (16.9% versus 8.2%, P < 0.001). However, the change in LFC in the group without an ASM/W increase showed no significant difference (12.5% versus 15.0%, P > 0.05). △ASM/W _{Follow-up-Baseline} [odds ratio (OR)=1.48, 95% confidence interval (CI) 1.05-2.07, P = 0.024] and △total fat mass (OR=1.45, 95% CI 1.12-1.87, P = 0.004) were independent predictors for steatosis improvement (relative reduction of LFC ≥ 30%). The subgroup analysis showed that, despite without weight loss, decrease in HOMA-IR (OR=6.21, 95% CI 1.28-30.13, P=0.023), △total fat mass _{Baseline -Follow-up} (OR=3.48, 95% CI 1.95-6.21, P <0.001 and △ASM/W _{Follow-up-Baseline} (OR=2.13, 95% CI 1.12-4.05, P=0.022) independently predicted steatosis improvement.

Conclusions

ASM/W increase and loss of total fat mass benefit the resolution of liver steatosis, independent of weight loss for MAFLD.

Supplementary information

The online version contains supplementary material available at 10.1186/s13395-023-00333-z.

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Most cited references 44

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Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Liang-Kung Chen, Jean Woo, Prasert Assantachai … (2020)

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.

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A new definition for metabolic associated fatty liver disease: an international expert consensus statement

Mohammed Eslam, Philip N. Newsome, Quentin M Anstee … (2020)

The exclusion of other chronic liver diseases including "excess" alcohol intake has until now been necessary to establish a diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD). However, given our current understanding of the pathogenesis of MAFLD and its rising prevalence, "positive criteria" to diagnose the disease are required. In this work, a panel of international experts from 22 countries propose a new definition for the diagnosis of MAFLD that is both comprehensive and simple, and is independent of other liver diseases. The criteria are based on evidence of hepatic steatosis, in addition to one of the following three criteria, namely overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. We propose that disease assessment and stratification of severity should extend beyond a simple dichotomous classification to steatohepatitis vs. non-steatohepatitis. The group also suggests a set of criteria to define MAFLD-associated cirrhosis and proposes a conceptual framework to consider other causes of fatty liver disease. Finally, we bring clarity to the distinction between diagnostic criteria and inclusion criteria for research studies and clinical trials. Reaching consensus on the criteria for MAFLD will help unify the terminology (e.g. for ICD-coding), enhance the legitimacy of clinical practice and clinical trials, improve clinical care and move the clinical and scientific field of liver research forward.

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Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis

Jie Li, Biyao Zou, Yee Yeo … (2019)

Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. Asia is a large, heterogeneous area with substantial variation in socioeconomic status and prevalence of obesity. We estimated the prevalence, incidence, and outcomes of NAFLD in the Asian population to assist stakeholders in understanding NAFLD disease burden.

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Author and article information

Contributors

Shuyu Zhuo: zhuoshy@mail.sysu.edu.cn

Bihui Zhong:

ORCID: https://orcid.org/0000-0002-4638-7699

zhongbh@mail.sysu.edu.cn

Journal

Journal ID (nlm-ta): Skelet Muscle

Journal ID (iso-abbrev): Skelet Muscle

Title: Skeletal Muscle

Publisher: BioMed Central (London )

ISSN (Electronic): 2044-5040

Publication date (Electronic): 19 December 2023

Publication date PMC-release: 19 December 2023

Publication date Collection: 2023

Volume: 13

Electronic Location Identifier: 23

Affiliations

[1 ]Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, ( https://ror.org/0064kty71) No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080 China

[2 ]Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, ( https://ror.org/0064kty71) No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080 Guangdong China

[3 ]Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, ( https://ror.org/0064kty71) No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080 Guangdong China

[4 ]Department of Nutrition, The First Affiliated Hospital, Sun Yat-sen University, ( https://ror.org/0064kty71) No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510080 Guangdong China

Author information

Bihui Zhong https://orcid.org/0000-0002-4638-7699

Article

Publisher ID: 333

DOI: 10.1186/s13395-023-00333-z

PMC ID: 10731792

PubMed ID: 38115119

SO-VID: b518a5ab-ecd6-468e-a12a-e9de001197c8

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 29 May 2023

Date accepted : 30 November 2023

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ScienceOpen disciplines: Rheumatology

Keywords: metabolic associated fatty liver disease,relative skeletal muscle mass,treatment response,liver fat content,weight loss

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ScienceOpen disciplines: Rheumatology

Keywords: metabolic associated fatty liver disease, relative skeletal muscle mass, treatment response, liver fat content, weight loss

Restoring skeletal muscle mass as an independent determinant of liver fat deposition improvement in MAFLD

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Karger: Nutrition and Dietetics

Most cited references 44

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

A new definition for metabolic associated fatty liver disease: an international expert consensus statement

Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999–2019: a systematic review and meta-analysis

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