Longitudinal Associations Between Hand Grip Strength and Non-Alcoholic Fatty Liver Disease in Adults: A Prospective Cohort Study.

Yang Xia,Ge Meng,Kaijun Niu,Qiyu Jia,Qing Zhang,Yashu Liu,Xuena Wang,Li Liu,Yuhong Zhao,Hongmei Wu,Ming Zhou,Yawen Wang,Kun Song,Limin Cao,Xing Wang,Yeqing Gu,Tingjing Zhang,Shaomei Sun,Shunming Zhang

doi:10.3389/fmed.2021.752999

Abstract

Purpose: This study aimed to determine the longitudinal association between hand grip strength (HGS) and the development of non-alcoholic fatty liver disease (NAFLD) in adults.Design: A cohort study.Methods: This study was conducted in a general Chinese population (n = 14,154) from 2013–2018. NAFLD was diagnosed by liver ultrasonography during evaluating alcohol consumption. The associations between the HGS and NAFLD were assessed using a multivariable Cox proportional hazards regression model.Results: During the study period with a mean follow-up duration of 3.20 years, 2,452 participants developed NAFLD. The risk of NAFLD decreased progressively with increasing HGS in both men and women (P for trend <0.0001). The multivariate-adjusted hazard ratios (95% CI) for NAFLD incidence across the quartiles of HGS were 1 (reference), 0.90 (0.79, 1.02), 0.69 (0.60, 0.79), and 0.44 (0.37, 0.52) for men and 1 (reference), 0.82 (0.69, 0.96), 0.54 (0.45, 0.66), and 0.41 (0.33, 0.52) for women, respectively. The interaction terms for body mass index (BMI)-HGS and waist-HGS were significant in men and women (all P < 0.0001). The participants with normal BMIs and waist circumferences had the lowest hazard ratios on the subgroup analyses. The sensitivity analysis that defined NAFLD using the hepatic steatosis and fatty liver indices revealed results that were similar to the main analyses.Conclusion: The present study indicates that the HGS is inversely associated with the incidence of NAFLD.

Highlights

The non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver diseases not attributable to alcohol consumption, such as simple fatty infiltration, inflammation, and cirrhosis
The present study indicates that the hand grip strength (HGS) is inversely associated with the incidence of NAFLD
Between 2013 and 2018, a total of 29,551 participants had at least two health examinations with adequate data related to the NAFLD diagnosis, Abbreviations: AFLD, alcoholic fatty liver disease; AUC, area under the curve; BMI, body mass index; CI, confidence interval; Food Frequency Questionnaire (FFQ), food frequency questionnaire; FLI, fatty liver index; HGS, hand grip strength; HIS, hepatic steatosis index; HRs, hazard ratios; MET, metabolic equivalent; NAFLD, non-alcoholic fatty liver disease; OR, odds ratio; Q, quartile; ROC, receiver operating characteristics; Self-Rating Depression Scale (SDS), self-rating depression scale

Summary

Introduction

The non-alcoholic fatty liver disease (NAFLD) represents a spectrum of liver diseases not attributable to alcohol consumption, such as simple fatty infiltration, inflammation, and cirrhosis. The NAFLD is one of the most important causes of liver disease [1] and the previous studies have demonstrated that it is associated with metabolic syndrome [2], diabetes [3], and hypertension [4]. As reported in a meta-analysis conducted in 2016, 25% of the global adult population were afflicted with NAFLD [5]. In China, the prevalence of NAFLD among adults in the general population is >20% and has paralleled the increase in obesity [6]. The obesity prevalence rose from 3.1% (2.5–3.7) in 2004 to 8.1% (7.6–8.7) in 2018 [7]. In parallel with increasing prevalence, the economic burden of NAFLD is enormous, especially at the time of diagnosis [8]. It is important to identify the modifiable risk factors and develop preventive strategies

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