TY - JOUR
T1 - Skeletal muscle mass to visceral fat area ratio as a predictor of nonalcoholic fatty liver disease in lean and overweight men and women with effect modification by sex
AU - Cho, Yoosun
AU - Chang, Yoosoo
AU - Ryu, Seungho
AU - Jung, Hyun-Suk
AU - Kim, Chan-won
AU - Oh, Hyungseok
AU - Kim, Mi Kyung
AU - Sohn, Won
AU - Shin, Hocheol
AU - Wild, Sarah H
AU - Byrne, Christopher D
N1 - Funding Information:
We thank our staff members at the Kangbuk Samsung Health Study for their hard work, dedication, and continuing support. This study was supported by the SKKU Excellence in Research Award Research Fund, Sungkyunkwan University, 2020, and by the National Research Foundation of Korea, funded by the Ministry of Science, ICT & Future Planning (NRF-2021R1A2C1012626). CDB is supported in part by the Southampton National Institute for Health Research Biomedical Research Center (IS-BRC-20004), UK.
Funding Information:
We thank our staff members at the Kangbuk Samsung Health Study for their hard work, dedication, and continuing support. This study was supported by the SKKU Excellence in Research Award Research Fund, Sungkyunkwan University, 2020, and by the National Research Foundation of Korea, funded by the Ministry of Science, ICT & Future Planning (NRF‐2021R1A2C1012626). CDB is supported in part by the Southampton National Institute for Health Research Biomedical Research Center (IS‐BRC‐20004), UK.
Publisher Copyright:
© 2022 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - The effect of sarcopenic visceral obesity on the risk of nonalcoholic fatty liver disease (NAFLD) is uncertain. We investigated (a) whether the skeletal muscle mass to visceral fat area ratio (SV ratio), as a measure of sarcopenic visceral obesity, is a risk factor for NAFLD; and (b) whether the SV ratio adds to conventional adiposity measures to improve prediction of incident NAFLD. Adults without NAFLD (n = 151,017) were followed up for a median of 3.7 years. Hepatic steatosis was measured using ultrasonography, and liver fibrosis scores were estimated using the Fibrosis-4 index (FIB-4) and the NAFLD Fibrosis Score (NFS). Cox proportional hazards models were used to determine sex-specific adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]). The incremental predictive performance was assessed using the area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Multivariable aHRs (95% CIs) for incident NAFLD comparing the lowest versus the highest quintile of SV ratio were 3.77 (3.56–3.99) for men and 11.69 (10.46–13.06) for women (p–interaction by sex < 0.001). For incident NAFLD with intermediate/high FIB-4, aHRs were 2.83 (2.19–3.64) for men and 7.96 (3.85–16.44) for women (similar results were obtained for NFS). Associations remained significant even after adjustment for body mass index, waist circumference, and time-varying covariates. These associations were also more pronounced in nonobese than obese participants (p–interaction < 0.001). The addition of SV ratio to conventional adiposity measures modestly improved risk prediction for incident NAFLD. SV ratio was inversely associated with risk of developing NAFLD, with effect modification by sex and obesity. Conclusion: Low SV ratio is a complementary index to conventional adiposity measures in the evaluation of NAFLD risk.
AB - The effect of sarcopenic visceral obesity on the risk of nonalcoholic fatty liver disease (NAFLD) is uncertain. We investigated (a) whether the skeletal muscle mass to visceral fat area ratio (SV ratio), as a measure of sarcopenic visceral obesity, is a risk factor for NAFLD; and (b) whether the SV ratio adds to conventional adiposity measures to improve prediction of incident NAFLD. Adults without NAFLD (n = 151,017) were followed up for a median of 3.7 years. Hepatic steatosis was measured using ultrasonography, and liver fibrosis scores were estimated using the Fibrosis-4 index (FIB-4) and the NAFLD Fibrosis Score (NFS). Cox proportional hazards models were used to determine sex-specific adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]). The incremental predictive performance was assessed using the area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Multivariable aHRs (95% CIs) for incident NAFLD comparing the lowest versus the highest quintile of SV ratio were 3.77 (3.56–3.99) for men and 11.69 (10.46–13.06) for women (p–interaction by sex < 0.001). For incident NAFLD with intermediate/high FIB-4, aHRs were 2.83 (2.19–3.64) for men and 7.96 (3.85–16.44) for women (similar results were obtained for NFS). Associations remained significant even after adjustment for body mass index, waist circumference, and time-varying covariates. These associations were also more pronounced in nonobese than obese participants (p–interaction < 0.001). The addition of SV ratio to conventional adiposity measures modestly improved risk prediction for incident NAFLD. SV ratio was inversely associated with risk of developing NAFLD, with effect modification by sex and obesity. Conclusion: Low SV ratio is a complementary index to conventional adiposity measures in the evaluation of NAFLD risk.
KW - Adult
KW - Female
KW - Fibrosis
KW - Humans
KW - Intra-Abdominal Fat/diagnostic imaging
KW - Male
KW - Muscle, Skeletal/diagnostic imaging
KW - Non-alcoholic Fatty Liver Disease/diagnostic imaging
KW - Obesity, Abdominal/complications
KW - Obesity/epidemiology
KW - Overweight/complications
KW - Sarcopenia/complications
U2 - 10.1002/hep4.1975
DO - 10.1002/hep4.1975
M3 - Article
C2 - 35503803
SN - 2471-254X
VL - 6
SP - 2238
EP - 2252
JO - Hepatology Communications
JF - Hepatology Communications
IS - 9
ER -