Background and aims

Sarcopenia is associated with worse prognosis for non-alcoholic fatty liver disease (NAFLD). However, disease progression in the MAFLD-related sarcopenia is largely unknown. We aimed to clarify the relationship between MAFLD and/or sarcopenia with mortality and liver fibrosis in the real world.

Methods

A total of 13,692 individuals were selected from the third National Health and Nutrition Examination Surveys and linked mortality until December 2019. MAFLD is diagnosed based on a radiologically diagnosed hepatic steatosis and the presence of any one of the following three conditions: overweight/obesity, diabetes mellitus (DM), or metabolic dysregulation. Sarcopenia is defined by weight-adjusted skeletal muscle mass.

Results

The mean age was 43.7 ± 15.97 years, and 47.3% of the individuals were male. MAFLD was diagnosed in 4207/13,692 (30.73%) participants, and the proportion of sarcopenic was 19.42% amongst subjects with MAFLD. The mean follow-up duration was of 23.7 ± 7.62 years. MAFLD (aHR 1.152, 95% CI 1.070–1.241) and sarcopenia (aHR 1.123, 95% CI 1.042–1.210) were related to increased all-cause mortality in MAFLD after adjustment for age, sex, race, marital status, education, and smoking. Stratified analysis revealed that MAFLD and sarcopenia additively increased the risk of mortality (aHR 1.247, 95% CI 1.132–1.373) and liver fibrosis (aOR 2.296, 95% CI 1.718–3.069 assessed by NFS score >0.676; aOR 2.218, 95% CI 1.788–2.752 assessed by FIB-4 score >1.3) in fully adjusted models (P < 0.001 for all).

Conclusion

Sarcopenia in individuals with MAFLD portends increased mortality and significant liver fibrosis. Novel therapeutic strategies targeting at increasing skeletal muscle mass should be explored for patients with MAFLD.

中文翻译：

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代谢相关的脂肪肝疾病和肌肉减少症会增加死亡率：一项真实世界研究

背景和目标

肌肉减少症与非酒精性脂肪肝病 (NAFLD) 的预后较差相关。然而，MAFLD 相关肌肉减少症的疾病进展在很大程度上尚不清楚。我们的目的是阐明现实世界中 MAFLD 和/或肌肉减少症与死亡率和肝纤维化之间的关系。

方法

截至 2019 年 12 月，第三次全国健康和营养检查调查共选取了 13,692 名个体，并与死亡率相关联。MAFLD 的诊断依据是放射学诊断的肝脂肪变性以及存在以下三种情况中的任何一种：超重/肥胖、糖尿病糖尿病 (DM) 或代谢失调。肌肉减少症是根据体重调整的骨骼肌质量来定义的。

结果

平均年龄为 43.7 ± 15.97 岁，其中 47.3% 为男性。4207/13,692 名受试者（30.73%）被诊断为 MAFLD，MAFLD 受试者中肌少症比例为 19.42%。平均随访时间为 23.7 ± 7.62 年。调整年龄、性别、种族、婚姻状况、教育程度和收入后，MAFLD（aHR 1.152，95% CI 1.070–1.241）和肌少症（aHR 1.123，95% CI 1.042–1.210）与 MAFLD 全因死亡率增加相关。抽烟。分层分析显示，MAFLD 和肌肉减少症会增加死亡风险（aHR 1.247，95% CI 1.132–1.373）和肝纤维化风险（aOR 2.296，95% CI 1.718–3.069，根据 NFS 评分 >0.676 评估；aOR 2.218，95% CI 1.788–2.752（根据 FIB-4 评分 >1.3 评估）在完全调整的模型中（ 所有P < 0.001）。

结论

MAFLD 患者的肌肉减少症预示着死亡率增加和明显的肝纤维化。应针对 MAFLD 患者探索针对增加骨骼肌质量的新治疗策略。