Abstract
We sought to identify the frequencies of presarcopenia, sarcopenia, and sarcopenic obesity in patients with nonalcoholic fatty liver disease (NAFLD) and to cross-sectionally determine the nutritional and dietary factors associated with loss of skeletal muscle mass in such patients. Dietary and body component changes produced by a diet intervention were longitudinally investigated. Forty-six NAFLD patients (24 males and 22 females) were enrolled. A second diet treatment was performed at 6 months after entry in 19 of the enrolled patients (6 males and 13 females). Body compositions and dietary nutrients at six months later were compared with those at entry. Three of the 24 (13%) males and four of the 22 (18%) females fulfilled the criteria for presarcopenia and one (5%) female NAFLD patient was in the criteria for sarcopenia at baseline. None of the patients were in the criteria for sarcopenic obesity. The factors associated with skeletal muscle index in the males were body mass index (BMI), insulin-like growth factor-1, total energy intake, and lipid intake, but only BMI and bone mineral density in females at baseline. The diet intervention decreased the skeletal muscle mass in the 6 males by decreasing the total energy intake via lower protein and lipid intakes and improved their liver dysfunction. In the 13 females, a decrease in total energy intake via lower carbohydrate and lipid intake did not change the skeletal muscle mass. These results suggest that loss of skeletal muscle mass is frequently observed in nonobese NAFLD patients and that the frequency of sarcopenic obesity seems to be rare in NAFLD patients. The nutritional and dietary factors that regulate loss of skeletal muscle mass were distinct between our male and female NAFLD patients. Thus, the skeletal muscle mass of such patients as well as their body weight and liver function should be monitored during diet interventions.
Highlights
Sarcopenia, a concept proposed by Rosenberg [1] in 1989, characterized by loss of skeletal muscle mass and low muscle strength, is widely recognized as a primary factor responsible for frailty [2] and is regulated by muscle mass, muscle strength, and physical performance [3]. e clinical outcomes of sarcopenia in Asian countries appears to be more serious than those in Western countries, because in Asian countries, the aging of the population is in rapid progress and the proportion of older individuals continues to increase. e physical status, ethnicity, and lifestyle in Asian countries differ in many ways from those in Western countries. erefore, original diagnostic criteria for sarcopenia that are appropriate for Asian people were required [4]
Patients’ Characteristics. e clinical characteristics of the 46 nonalcoholic fatty liver disease (NAFLD) patients (24 males, 22 females) enrolled in this study at baseline are shown in Table 1. e age was lower in male patients than in female patients but not significant
E values of HOMA-IR ranged from 0.82 to 5.2 among ten male and nine female patients. Four of these 10 (40%) males and four of the nine (44.4%) females met the category for insulin resistance, respectively. e values of HOMA-IR were almost equal between the males and the females
Summary
Sarcopenia, a concept proposed by Rosenberg [1] in 1989, characterized by loss of skeletal muscle mass and low muscle strength, is widely recognized as a primary factor responsible for frailty [2] and is regulated by muscle mass, muscle strength, and physical performance [3]. e clinical outcomes of sarcopenia in Asian countries appears to be more serious than those in Western countries, because in Asian countries, the aging of the population is in rapid progress and the proportion of older individuals continues to increase. e physical status, ethnicity, and lifestyle in Asian countries differ in many ways from those in Western countries. erefore, original diagnostic criteria for sarcopenia that are appropriate for Asian people were required [4]. Sarcopenia, a concept proposed by Rosenberg [1] in 1989, characterized by loss of skeletal muscle mass and low muscle strength, is widely recognized as a primary factor responsible for frailty [2] and is regulated by muscle mass, muscle strength, and physical performance [3]. Outcome-based data were not available in Asian Working Group for Sarcopenia (AWGS). Erefore, the working group aimed to standardize the cutoff values for evaluating sarcopenia in Asian people. Sarcopenia is largely classified into two categories: primary sarcopenia and secondary sarcopenia [3]. Inflammatory cytokines and myokines, including interleukin-6 (IL-6) and myostatin, are thought to affect the skeletal muscle mass [14]
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