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      Sarcopenia and non-alcoholic fatty liver disease: Is there a relationship? A systematic review

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          Abstract

          AIM

          To perform a systematic review to evaluate the incidence and prevalence of non-alcoholic fatty liver disease (NAFLD) in adult patients with sarcopenia.

          METHODS

          Randomized clinical trials, cross-sectional or cohort studies including adult patients (over 18 years) with sarcopenia were selected. The primary outcomes of interest were the prevalence or incidence of NAFLD in sarcopenic patients. In the screening process, 44 full-text articles were included in the review and 41 studies were excluded.

          RESULTS

          Three cross-sectional studies were included. The authors attempted to perform a systematic review, but due to the differences between the studies, a qualitative synthesis was provided. The diagnosis of NAFLD was made by non-invasive methods (image methods or any surrogate markers) in all three evaluated studies. All the studies suggested that there was an independent association between sarcopenia and NAFLD.

          CONCLUSION

          Sarcopenia is independently associated with NAFLD and possibly to an advanced fibrosis.

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          Improving the quality of reporting of randomized controlled trials. The CONSORT statement.

          C. Begg, M. Cho, S. Eastwood … (1996)
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            Epidemiology of Non-Alcoholic Fatty Liver Disease

            Stefano Bellentani, Federica Scaglioni, Mariano Marino … (2010)
            Non-alcoholic fatty liver disease (NAFLD) is rapidly becoming the most common liver disease worldwide. The prevalence of NAFLD in the general population of Western countries is 20–30%. About 2–3% of the general population is estimated to have non-alcoholic steatohepatitis (NASH), which may progress to liver cirrhosis and hepatocarcinoma. As a rule, the prevalence of NAFLD is higher in males and increases with increasing age, and it is influenced by the diagnostic method and the characteristics of the population, especially lifestyle habits. Population-based studies provide better estimates of the prevalence of NAFLD as compared to autoptic and clinical studies, but few such studies have been performed to date. The diagnosis of NAFLD in population studies is usually obtained by ultrasonography, which is known to underestimate the prevalence of fatty liver. The Dallas Heart Study and the Dionysos Study reported that 30% of the adults in the USA and 25% in Italy have NAFLD. In these studies, 79% and 55% of patients with NAFLD had normal aminotransferase levels, showing that liver enzymes are not surrogate markers of NAFLD in the general population. Noninvasive markers such as the fatty liver index obtained from the Dionysos Study may be useful to screen for NAFLD in the general population. The most important risk factors for NAFLD are male gender, age, obesity, insulin resistance and the cardiometabolic alterations that define the metabolic syndrome. The prevalence of NAFLD is 80–90% in obese adults, 30–50% in patients with diabetes and up to 90% in patients with hyperlipidemia. The prevalence of NAFLD among children is 3–10%, rising up to 40–70% among obese children. Moreover, pediatric NAFLD increased from about 3% a decade ago to 5% today, with a male-to-female ratio of 2:1. The incidence and natural history of NAFLD are still not well defined, but it is recognized that the majority of individuals with NAFLD do not develop NASH. The incidence of NAFLD is probably increasing in Western countries, strictly linked to lifestyle habits.
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              Sarcopenic Obesity: Prevalence and Association With Metabolic Syndrome in the Korean Longitudinal Study on Health and Aging (KLoSHA)

              Soo-Young Lim, Jung-Hee Kim, Ji Won Yoon … (2010)
              OBJECTIVE We investigated the prevalence of sarcopenic obesity (SO) and its relationship with metabolic syndrome in a community-based elderly cohort in Korea. RESEARCH DESIGN AND METHODS In this study, 287 men and 278 women aged 65 or older were recruited. Sarcopenia was defined as the appendicular skeletal muscle mass (ASM) divided by height squared (Ht2) (kg/m2) or by weight (Wt) (%) of <1 SD below the sex-specific mean for young adults. Obesity was defined as a visceral fat area ≥100 cm2. RESULTS The prevalence of SO was 16.7% in men and 5.7% in women with sarcopenia defined by ASM/Ht2; however, it was 35.1% in men and 48.1% in women by ASM/Wt. Using ASM/Wt, the homeostasis model assessment of insulin resistance of subjects with SO was higher and they were at higher risk for metabolic syndrome (odds ratio [OR] 8.28 [95% CI 4.45–15.40]) than the obese (5.51 [2.81–10.80]) or sarcopenic group (2.64 [1.08–6.44]). CONCLUSIONS SO defined by ASM/Wt was more closely associated with metabolic syndrome than either sarcopenia or obesity alone.
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Hepatol
                Journal ID (publisher-id): WJH
                Title: World Journal of Hepatology
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 1948-5182
                Publication date (Print): 28 February 2017
                Publication date (Electronic): 28 February 2017
                Volume: 9
                Issue: 6
                Pages: 326-332
                Affiliations
                Cristiane V Tovo, Sabrina A Fernandes, Caroline Buss, Angelo A de Mattos, Postgraduate Program at Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS 90430-080, Brazil
                Cristiane V Tovo, Angelo A de Mattos, Clinical Medicine Department at Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS 90430-080, Brazil
                Sabrina A Fernandes, PostGraduate Program in Bioscience and Rehabilitation and the PostGraduate Program in Rehabilitation and Inclusion, Methodist University - IPA, Porto Alegre, RS 90420-060, Brazil
                Caroline Buss, Nutrition Department at Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS 90430-080, Brazil
                Author notes

                Author contributions: Tovo CV and Fernandes SA perfomed the data collection; all the authors wrote the paper and approved the final version.

                Correspondence to: Cristiane V Tovo, MD, PhD, Postgraduate Program at Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Cel Aurelio Bitencourt 115 apto 201, Porto Alegre, RS 90430-080, Brazil. cris.tovo@ 123456terra.com.br

                Telephone: +55-51-32148158 Fax: +55-51-32148158

                Article
                Other ID: jWJH.v9.i6.pg326
                DOI: 10.4254/wjh.v9.i6.326
                PMC ID: 5332422
                PubMed ID: 28293382
                SO-VID: 55de8cea-e1b0-45c0-9a49-2353381550a6
                Copyright © ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 7 September 2016
                Date revision received : 3 January 2017
                Date accepted : 8 February 2017
                Categories
                Subject: Systematic Reviews

                Keywords: metabolic syndrome,obesity morbid,sarcopenic obesity,steatohepatitis,skeletal muscle
                Data availability:
                Keywords: metabolic syndrome, obesity morbid, sarcopenic obesity, steatohepatitis, skeletal muscle

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