Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a systematic review and meta-analysis

Changzhou Cai, Xin Song, Yishu Chen, Xueyang Chen, Chaohui Yu, Changzhou Cai, Xin Song, Yishu Chen, Xueyang Chen, Chaohui Yu

Abstract

Background and aim: Nonalcoholic fatty liver disease (NAFLD) has gradually become one of the most common chronic liver diseases in the world. More and more evidence shows that low skeletal muscle mass index (SMI) may play a role in the development of NAFLD. Our aim was to quantify the association between SMI, sarcopenia and the presence and severity of NAFLD.

Methods: We systematically searched English relevant studies from PubMed, Embase, the Web of Science and the Cochrane Library updated to December 20th, 2018. Studies in which SMI was compared between NAFLD cases and controls were included. So were studies concerning the odds ratio (OR) of NAFLD, non-alcoholic steatohepatitis (NASH) and significant fibrosis in sarcopenia patients. Pooled weighted mean differences and ORs were calculated.

Results: Of the 1331 retrieved studies, 19 articles were included. SMI level in NAFLD patients was 1.77 (95% CI 1.15, 2.39) lower than that in normal controls. We also found a significantly higher occurrence risk of NAFLD (OR = 1.33, 95% CI 1.20 to 1.48), NASH (OR = 2.42, 95% CI 1.27 to 3.57) and NAFLD-related significant fibrosis (OR = 1.56, 95% CI 1.34, 1.78) in sarcopenia subjects.

Conclusions: SMI level in patients with NAFLD was lower than healthy people, and patients with sarcopenia have higher occurrence risk of NAFLD, as well as its advanced stages including NASH or NAFLD-related significant fibrosis. Further well-designed prospective studies are required to strengthen the arguments.

Keywords: Liver fibrosis; Nonalcoholic fatty liver disease; Sarcopenia; Skeletal muscle mass; Steatohepatitis.

Conflict of interest statement

Changzhou Cai, Xin Song, Yishu Chen, Xueyang Chen and Chaohui Yu declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart showing the selection of articles included in the meta-analysis
Fig. 2
Fig. 2
Meta-analysis of skeletal muscle index (SMI) in nonalcoholic fatty liver disease (NAFLD). a A pooled weighted mean difference (WMD) of SMI in overall seven individual studies between NAFLD patients and normal people. b A pooled WMD of SMI in subgroup analysis based on the different SMM measurement methods. c A pooled WMD of SMI in subgroup analysis according to gender. d Sensitivity analysis according to whether the study was in or out of the funnel plot. For each estimate, the grey shaded area is the weight of the estimate in proportion to the overall effect. SMI skeletal muscle index, NAFLD nonalcoholic fatty liver disease, WMD weighted mean difference, NC normal control, SMM skeletal muscle mass, DEXA dual energy X-ray absorptiometry, BIA bioimpedance analysis
Fig. 3
Fig. 3
Meta-analysis of sarcopenia in nonalcoholic fatty liver disease (NAFLD). a A pooled odds ratio (OR) of NAFLD prevalence between sarcopenia patients and normal control (NC). b Subgroup analysis according to race. c Subgroup analysis based on the sample size. d Sensitivity analysis according to whether the study was in or out of the funnel plot. For each estimate, the grey shaded area is the weight of the estimate in proportion to the overall effect. NAFLD nonalcoholic fatty liver disease, NC normal control, OR odds ratio, HSI hepatic steatosis index, CNS comprehensive NAFLD score, NFS NAFLD fibrosis score, BMI body mass index
Fig. 4
Fig. 4
Meta-analysis of sarcopenia in nonalcoholic fatty liver disease (NAFLD). a A pooled odds ratio (OR) of NAFLD-related significant fibrosis between sarcopenia patients and normal control (NC). b Subgroup analysis according to race. c In NAFLD patients, a pooled OR of NASH between sarcopenia patients and control. d In analyzing the association in patients with sarcopenia and NAFLD-related significant fibrosis. Subgroup analysis was performed based on the diagnostic methods. NAFLD nonalcoholic fatty liver disease, OR: odds ratio, NFS NAFLD fibrosis score, FIB-4 fibrosis index based on the 4 factor, BMI body mass index

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