Aim To investigate whether non-alcoholic fatty liver disease (NAFLD) in individuals without generalized obesity is associated with visceral fat obesity (VFO), sarcopenia, and/or myosteatosis. Methods This cross-sectional analysis included 14,400 individuals (7,470 men) who underwent abdominal computed tomography (CT) scans during routine health examinations. The total abdominal muscle area (TAMA) and skeletal muscle area (SMA) at the 3rd lumbar vertebral level were measured. The SMA was divided into the normal attenuation muscle area (NAMA) and low attenuation muscle area, and the NAMA/TAMA index was calculated. VFO was defined by visceral to subcutaneous fat ratio (VSR), sarcopenia by BMI-adjusted SMA, and myosteatosis by the NAMA/TAMA index. NAFLD was diagnosed with ultrasonography. Results Of the 14,400 individuals, 4,748 (33.0%) had NAFLD, and the prevalence of NAFLD among non-obese individuals was 21.4%. In regression analysis, both sarcopenia (men: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.19-1.67, p<0.001; women: OR=1.59, 95% CI 1.40-1.90, p<0.001) and myosteatosis (men: OR=1.24, 95% CI 1.02-1.50, p=0,028; women: OR=1.23, 95% CI 1.04-1.46, p=0.017) were significantly associated with non-obese NAFLD after considering for VFO and other various risk factors, whereas VFO (men: OR=3.97, 95% CI 3.43-¬4.59 [adjusted for sarcopenia], OR 3.98, 95% CI 3.44-4.60 [adjusted for myosteatosis]; women: OR=5.42, 95% CI 4.53-6.42 [adjusted for sarcopenia], OR=5.33, 95% CI 4.51-6.31 [adjusted for myosteatosis]; all p<0.001) was strongly associated with non-obese NAFLD after adjustment with various known risk factors. Conclusions In addition to VFO, sarcopenia and/or myosteatosis were significantly associated with non-obese NAFLD.

中文翻译：

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内脏脂肪肥胖、肌肉减少症和肌脂肪变性与无肥胖的非酒精性脂肪肝的关联。

目的 调查非全身性肥胖个体的非酒精性脂肪肝 (NAFLD) 是否与内脏脂肪肥胖 (VFO)、肌肉减少症和/或肌脂肪变性相关。方法 这项横断面分析包括 14,400 名个体（7,470 名男性），他们在常规健康检查期间接受了腹部计算机断层扫描 (CT) 扫描。测量第三腰椎水平的总腹肌面积（TAMA）和骨骼肌面积（SMA）。将SMA分为正常衰减肌肉区（NAMA）和低衰减肌肉区，并计算NAMA/TAMA指数。VFO 由内脏与皮下脂肪比 (VSR) 定义，肌少症由 BMI 调整的 SMA 定义，肌脂肪变性由 NAMA/TAMA 指数定义。NAFLD 通过超声检查诊断。结果 14,400 人中，4,748 人（33.0%）患有 NAFLD，非肥胖人群 NAFLD 患病率为 21.4%。在回归分析中，肌肉减少症（男性：比值比 (OR) 1.41，95% 置信区间 (CI) 1.19-1.67，p<0.001；女性：OR=1.59，95% CI 1.40-1.90，p<0.001）和肌脂肪变性（男性：OR=1.24，95% CI 1.02-1.50，p=0,028；女性：OR=1.23，95% CI 1.04-1.46，p=0.017）在考虑 VFO 和其他各种因素后，与非肥胖 NAFLD 显着相关。危险因素，而 VFO（男性：OR=3.97，95% CI 3.43-‐4.59 [根据肌少症调整]，OR 3.98，95% CI 3.44-4.60 [根据肌脂肪变性调整]；女性：OR=5.42，95% CI 4.53 -6.42 [针对肌肉减少症进行调整]，OR=5.33，95% CI 4.51-6.31 [针对肌脂肪变性进行调整]；所有 p<0.001）在调整各种已知危险因素后与非肥胖 NAFLD 密切相关。结论 除了 VFO 之外，肌肉减少症和/或肌脂肪变性与非肥胖 NAFLD 显着相关。