Abstract
Background: Recent studies in adult non-elderly and elderly individuals have reported a link between nonalcoholic fatty liver disease (NAFLD) and sarcopenia. Nonetheless, whether this relationship would be found outside these populations it is still unknown. Hence, we evaluated the relationship between NAFLD and skeletal muscle mass in children and adolescents with overweight/obesity.Methods: Two-hundred and thirty-four overweight/obese youths were enrolled. NAFLD was diagnosed by ultrasononography, after exclusion of infectious and metabolic disorders. Forty of the patients with NAFLD had also liver biopsy. Total and regional lean body mass and total fat mass measurements were obtained by dual-energy X-ray absorptiometry. The relative muscle mass (RMM) was defined as the percent of muscle mass (kg) relative to the sum of muscle and fat (kg) mass. Appendicular skeletal muscle mass (ASM) was calculated by the sum of muscle masses of the four limbs (kg), and expressed as percent of body weight.Results: Subjects were stratified according to tertiles of RMM. The prevalence of abdominal obesity, dyslipidemia, insulin resistance, metabolic syndrome, NAFLD as well as biopsy-proven nonalcoholic steatohepatitis (NASH) was significantly increased in the lowest tertile of RMM. After controlling for age, sex and Tanner stage, children in the lowest tertile of RMM had an increased risk for NAFLD (OR= 2.80, 95% CI=1.57–5.02) compared to those in the other two tertiles. This association persisted after additional adjustments for clinical and metabolic variables. Similarly, the risk of NAFLD in the lowest tertile of ASM/weight index was significantly higher compared to those in the other two tertiles after adjustment for the above confounders.Conclusions: This is the first study to establish an independent association between low muscle mass and NAFLD/NASH in overweight/obese youths. Considering the worldwide increase of pediatric obesity, measurements of muscle mass may serve as useful method of identifying among obese children those at high metabolic risk who may need intensive lifestyle interventions to prevent NAFLD and its progression.
Highlights
With the worldwide epidemic of obesity, nonalcoholic fatty liver disease (NAFLD) has emerged as the most prevalent chronic liver disease in adults as well as youths [1], and a rising indication for liver transplantation
Reduced relative muscle mass (RMM) was significantly associated with an increased prevalence of NAFLD (P = 0.006)
We demonstrated that [1] overweight/obese youths with lower muscle mass have a greater risk of NAFLD compared to those with higher muscle mass; [2] the inverse association between NAFLD and muscle mass in children and adolescents is independent from anthropometric and metabolic variables; and [3] overweight/obese youths with lower muscle mass have a greater prevalence of cardiometabolic risk factors as well as metabolic syndrome (MetS)
Summary
With the worldwide epidemic of obesity, nonalcoholic fatty liver disease (NAFLD) has emerged as the most prevalent chronic liver disease in adults as well as youths [1], and a rising indication for liver transplantation. NAFLD include a broad range of liver damage from simple steatosis, nonalcoholic steatohepatitis (NASH), to cirrhosis [2] Both adult and pediatric patients with NAFLD often manifest features of metabolic syndrome (MetS) (e.g., abdominal obesity, increased blood pressure, atherogenic dyslipidemia, insulin resistance, and glucose abnormalities), and are at greater risk for cardiovascular disease (CVD) [3,4,5]. Several studies have reported in the adult nonelderly and elderly populations a link between sarcopenia and NAFLD [13], highlighting sarcopenia as an emerging risk factor for NAFLD and its progression Whether this relationship would be found outside these populations it is still unknown. Recent studies in adult non-elderly and elderly individuals have reported a link between nonalcoholic fatty liver disease (NAFLD) and sarcopenia We evaluated the relationship between NAFLD and skeletal muscle mass in children and adolescents with overweight/obesity
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