Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2023; 29(45): 5962-5973
Published online Dec 7, 2023. doi: 10.3748/wjg.v29.i45.5962
Association of low muscle strength with metabolic dysfunction-associated fatty liver disease: A nationwide study
Gyu Bae Lee, Youn Huh, Sang Hyun Lee, Byoungduck Han, Yang-Hyun Kim, Do-Hoon Kim, Seon Mee Kim, Youn Seon Choi, Kyung Hwan Cho, Ga Eun Nam
Gyu Bae Lee, Byoungduck Han, Yang-Hyun Kim, Do-Hoon Kim, Seon Mee Kim, Youn Seon Choi, Kyung Hwan Cho, Ga Eun Nam, Department of Family Medicine, Korea University College of Medicine, Seoul 02841, South Korea
Youn Huh, Department of Family Medicine, Uijeongbu Eulji Medical Center, EULJI University, Daejeon 11759, South Korea
Sang Hyun Lee, School of Electrical Engineering, Korea University, Seoul 02841, South Korea
Author contributions: Nam GE designed the study; Nam GE and Huh Y were responsible for developing the methodology; Nam GE, Huh Y, Lee GB, and Lee SH participated in the formal analysis and investigation; Lee GB wrote the original draft; Lee GB, Han B, Kim YH, Kim DH, Kim SM, Choi YS, Cho KH, and Nam GE participated in the review and editing; Nam GE acquired funding.
Institutional review board statement: The institutional review board of the Korea University Guro Hospital in Seoul, Republic of Korea approved the study protocol (No. 2022GR0322).
Informed consent statement: Signed informed consent was obtained from all participants.
Conflict-of-interest statement: The authors disclose no conflicts.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ga Eun Nam, MD, PhD, Associate Professor, Department of Family Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, South Korea. silver79@korea.ac.kr
Received: August 1, 2023
Peer-review started: August 1, 2023
First decision: September 30, 2023
Revised: October 30, 2023
Accepted: November 17, 2023
Article in press: November 17, 2023
Published online: December 7, 2023
Processing time: 121 Days and 15 Hours
ARTICLE HIGHLIGHTS
Research background

More evidence is needed regarding the association between muscle strength and metabolic dysfunction-associated fatty liver disease (MAFLD) and only a few cross-sectional studies have shown that sarcopenia was associated with liver fibrosis in patients with MAFLD. In response to the increasing public health burden of MAFLD in Asia, we investigated the association between muscle strength and MAFLD using a Korean nationally representative database.

Research motivation

A recent introduction has been made regarding a new definition: MAFLD. Importantly, MAFLD is associated with increased all-cause mortality and advanced fibrosis in MAFLD had a higher all-cause mortality risk than that in non-alcoholic fatty liver disease. However, the link between muscle strength and MAFLD is not well studied.

Research objectives

We aimed to investigate the association between muscle strength and MAFLD in the general population in Korea. Additionally, we sought to study the risk of liver fibrosis in patients with MAFLD according to muscle strength.

Research methods

This study used data from the Korea National Health and Nutrition Examination Survey. Muscle strength was assessed using relative handgrip strength and the participants were categorized into muscle strength quartiles. We performed multivariable logistic regression analysis to evaluate the association between muscle strength and the risk of MAFLD and calculated the odds ratios and 95% confidence intervals.

Research results

Twenty-nine point three per cent of the participants had MAFLD. The lowest quartile was significantly associated with higher prevalence of MAFLD for all participants, sexes, and age groups. In patients with MAFLD, the odds of severe liver fibrosis were higher in Q1 than in other groups (Q2–Q4). However, causality should be investigated in future studies.

Research conclusions

The nationwide study of the Korean adult population revealed that low muscle strength was associated with a dose-dependent higher risk of MAFLD in all participants and subgroups. Additionally, low muscle strength is associated with a high probability of liver fibrosis in patients with MAFLD. The identification and management of low muscle strength may play a crucial role in preventing MAFLD and liver fibrosis.

Research perspectives

Prospective cohort or randomized controlled trials are needed to confirm the relationship between muscle strength and MAFLD. Future studies should focus on whether physical activity can prevent or reverse MAFLD and liver fibrosis in patients with MAFLD.