Abstract
Nonalcoholic fatty liver is a worldwide common problem with more prevalence in non-Asian populations that is closely correlated with the muscle-related disorder sarcopenia. The incidence of both health issues has been observed to be strongly interlinked where presence of one exacerbates the other. Nonalcoholic fatty liver disease (NAFLD) pathophysiology increases the muscle loss, while the onset of NAFLD in sarcopenic patients aggravates the liver problems as compared to non-sarcopenic patients. Scarcity of research on the subject provides very little evidence about the cause and effect of disorders. No FDA approved drugs are available to date for NAFLD and sarcopenia. Research is underway to understand the complex biochemical pathways involved in the development of both disorders. This review is a small contribution toward understanding sarcopenia in the setting of NAFLD that provides insight on the common pathophysiological profile of sarcopenia and NAFLD and portrays a novel way of delving into the subject by introducing the concept of cortisol crosstalk with the muscle-liver axis. Sarcopenia and NAFLD are considered metabolism-related problems, and cortisol, being a glucocorticoid, plays an important role in metabolism of fats, carbohydrates, and proteins. Cushing’s syndrome, characterized by abnormally elevated concentrations of blood cortisol/enhanced intracellular activity, shares many pathologic conditions (such as insulin resistance, metabolic syndrome, abnormal levels of specific cytokines, and obesity) with NAFLD and sarcopenia. Hence, cortisol can be a potential biomarker in sarcopenia and NAFLD. As cortisol activity at cellular level is controlled by 11β-hydroxysteroid dehydrogenase type 1 and 2 (11β-HSD1/2) enzymes that convert inactive steroid precursor into active cortisol, these enzymes can be targeted for the study of sarcopenia and NAFLD. Combined studies on NAFLD and sarcopenia with respect to cortisol open a new avenue of research in the understanding of both disorders.
Highlights
The term “sarcopenia” was introduced by Irwin Rosenberg to refer to the loss of muscle mass in older people[1]
These results provide a strong basis of myosteatosis association with liver stiffness in Nonalcoholic fatty liver disease (NAFLD) and a sharp reduction in liver stiffness with a decrease in myosteatosis after three months[126]
Sarcopenia is a muscle-related disorder characterized by the gradual loss of muscle mass and function, while NAFLD is the hepatic accumulation of lipids that leads to end-stage liver problems
Summary
The term “sarcopenia” was introduced by Irwin Rosenberg to refer to the loss of muscle mass in older people[1]. Cai et al.[7] reported a strong association of sarcopenia with advanced stages of NAFLD and NASH They showed that the recovery of skeletal muscle mass might help in preventing the development and progression of NAFLD in healthy as well as in sarcopenic patients[7]. The incidence of sarcopenia was only 8.3%, while skeletal muscle fat index was relatively higher in patients with liver stiffness These results provide a strong basis of myosteatosis association with liver stiffness in NAFLD and a sharp reduction in liver stiffness with a decrease in myosteatosis after three months[126]. Individuals with this syndrome show increased and abnormal distribution of fatty mass (central obesity), hypertension, and IR They are prone to develop NAFLD due to fat accumulation in liver and adipose tissue and decreased muscle mass (sarcopenia) by GCs’ stimulation of protein breakdown and inhibition of protein synthesis[176]. These pieces of evidence indicate that anxiety and depressive symptoms alter the functioning of the HPA axis, which in turn might contribute to the development of diseases associated with chronic hypercortisolism
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
