Association of low muscle strength with metabolic dysfunction-associated fatty liver disease: A nationwide study

Table 1 Characteristics of study participants according to the quartiles of muscle strength

	Q1	Q2	Q3	Q4	P for trend
N (unweighted)	4305	4347	4397	4300
Age (yr)	55.9 ± 0.4	49.2 ± 0.4	44.6 ± 0.3	39.9 ± 0.2	< 0.001
Sex (men)	45.2 (1.0)	45.9 (0.9)	46.2 (0.9)	48.0 (0.9)	0.172
Current smoker	13.6 (0.7)	16.6 (0.7)	17.7 (0.7)	20.3 (0.8)	< 0.001
Physical activity	38.5 (1.0)	46.4 (1.0)	51.1 (0.9)	53.1 (0.9)	< 0.001
Income (lowest quartile)	28.8 (1.0)	16.5 (0.7)	10.7 (0.6)	8.0 (0.5)	< 0.001
Education (≤ 12 yr)	45.4 (1.2)	28.1 (0.9)	16.9 (0.7)	8.5 (0.5)	< 0.001
BMI (kg/m2)	26.0 ± 0.1	24.7 ± 0.1	23.5 ± 0.1	21.8 ± 0.1	< 0.001
Waist circumference (cm)	88.0 ± 0.2	84.0 ± 0.2	80.5 ± 0.2	76.3 ± 0.2	< 0.001
Handgrip strength (kg)	21.8 ± 0.2	27.8 ± 0.2	31.2 ± 0.2	35.6 ± 0.2	< 0.001
Muscle strength (handgrip strength/body mass index)	0.8 ± 0.01	1.1 ± 0.01	1.3 ± 0.01	1.6 ± 0.01	< 0.001
Systolic BP (mmHg)	122.7 ± 0.4	118.2 ± 0.3	115.2 ± 0.3	112.1 ± 0.3	< 0.001
Diastolic BP (mmHg)	75.3 ± 0.2	75.8 ± 0.2	75.2 ± 0.2	74.2 ± 0.2	< 0.001
AST (IU/L)	24.5 ± 0.2	23.1 ± 0.2	21.5 ± 0.2	20.2 ± 0.1	< 0.001
ALT (IU/L)	26.0 ± 0.5	24.2 ± 0.4	21.0 ± 0.3	18.4 ± 0.2	< 0.001
Total cholesterol (mg/dL)	191.4 ± 0.7	194.3 ± 0.7	194.1 ± 0.6	188.8 ± 0.6	< 0.001
HDL-C (mg/dL)	47.4 ± 0.2	49.9 ± 0.2	51.6 ± 0.2	54.0 ± 0.2	< 0.001
LDL-C (mg/dL)	115.0 ± 0.7	116.9 ± 0.6	116.5 ± 0.6	112.3 ± 0.5	< 0.001
Triglycerides (mg/dL)	145.6 ± 2.0	137.5 ± 2.0	130.1 ± 1.9	112.5 ± 1.6	< 0.001
Fasting glucose (mg/dL)	106.1 ± 0.5	100.8 ± 0.4	97.6 ± 0.4	93.8 ± 0.3	< 0.001
HbA1c (%)	5.9 ± 0.02	5.7 ± 0.01	5.6 ± 0.01	5.4 ± 0.01	< 0.001
hs-CRP (mg/L)	1.7 ± 0.04	1.2 ± 0.04	1.1 ± 0.03	0.8 ± 0.03	< 0.001
Obesity	56.7 (0.9)	44.0 (1.0)	28.7 (0.8)	11.6 (0.6)	< 0.001
Hypertension	45.4 (1.0)	30.5 (0.8)	21.5 (0.7)	12.4 (0.6)	< 0.001
Diabetes mellitus	22.5 (0.7)	13.1 (0.6)	7.8 (0.4)	3.9 (0.3)	< 0.001
Dyslipidemia	31.8 (0.9)	28.1 (0.9)	21.2 (0.7)	14.1 (0.6)	< 0.001

Data are presented as mean ± SE or percentage (SE). Q: Quartile; BMI: Body mass index; BP: Blood pressure; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin; hs-CRP: High-sensitivity C-reactive protein.

Table 2 Odds ratios (95% confidence intervals) of metabolic dysfunction-associated fatty liver disease according to the categories of muscle strength

Muscle strength	Model 1	Model 2	Model 3
Total
Q1	3.63 (3.34–3.95)	3.24 (2.94–3.58)	1.92 (1.70–2.16)
Q2–Q4	1 (reference)	1 (reference)	1 (reference)
P value
Q1	9.12 (7.98–10.41)	8.61 (7.41–10.01)	3.12 (2.64–3.69)
Q2	4.92 (4.29–5.64)	4.75 (4.10–5.50)	2.19 (1.85–2.58)
Q3	2.48 (2.17–2.84)	2.42 (2.10–2.78)	1.41 (1.22–1.65)
Q4	1 (reference)	1 (reference)	1 (reference)
P for trend	< 0.001	< 0.001	< 0.001
Men
Q1	3.51 (3.02–4.09)	3.31 (2.80–3.90)	2.05 (1.70–2.47)
Q2–Q4	1 (reference)	1 (reference)	1 (reference)
P value	< 0.001	< 0.001
Q1	7.30 (5.67–9.39)	7.20 (5.52–9.38)	2.88 (2.20–3.78)
Q2	3.68 (2.83–4.78)	3.68 (2.82–4.80)	1.75 (1.32–2.31)
Q3	2.02 (1.54–2.66)	2.03 (1.55–2.68)	1.23 (0.93–1.63)
Q4	1 (reference)	1 (reference)	1 (reference)
P for trend	< 0.001	< 0.001	< 0.001
Women
Q1	4.20 (3.74–4.71)	3.17 (2.79–3.60)	1.76 (1.47–2.10)
Q2–Q4	1 (reference)	1 (reference)	1 (reference)
P value	< 0.001	< 0.001	< 0.001
Q1	11.76 (9.87–14.02)	9.14 (7.56–11.05)	3.09 (2.43–3.92)
Q2	6.09 (5.15–7.20)	5.30 (4.47–6.30)	2.52 (2.05–3.10)
Q3	2.76 (2.34–3.26)	2.59 (2.20–3.06)	1.52 (1.25–1.85)
Q4	1 (reference)	1 (reference)	1 (reference)
P for trend	< 0.001	< 0.001	< 0.001

Odds ratios (95% confidence intervals) were calculated using multivariable logistic regression analysis; Model 1 = not adjusted; Model 2 = adjusted for age, sex, income, education, smoking status, and physical activity; Model 3 = Model 2 + alanine aminotransferase, obesity, hypertension, diabetes mellitus, dyslipidemia, and high-sensitivity C-reactive protein. Q: Quartile.

Table 3 Subgroup analysis for the association between muscle strength and metabolic dysfunction-associated fatty liver disease

	Muscle strength	OR (95%CI)	P for interaction
Sex			0.126
Men	Q2–Q4	1 (reference)
	Q1	2.05 (1.70–2.47)
Women	Q2–Q4	1 (reference)
	Q1	1.76 (1.47–2.10)
Age			0.057
< 65 yr	Q2–Q4	1 (reference)
	Q1	1.97 (1.70–2.29)
≥ 65 yr	Q2–Q4	1 (reference)
	Q1	1.74 (1.44–2.09)
Obesity			0.264
No	Q2–Q4	1 (reference)
	Q1	1.63 (1.36–1.96)
Yes	Q2–Q4	1 (reference)
	Q1	2.09 (1.75–2.48)
Diabetes mellitus			0.622
No	Q2–Q4	1 (reference)
	Q1	1.97 (1.72–2.26)
Yes	Q2–Q4	1 (reference)
	Q1	1.71 (1.33–2.22)

Odds ratios (95% confidence intervals) were calculated using multivariable logistic regression analysis after adjusting for age, sex, income, education, smoking status, physical activity, alanine aminotransferase, obesity, hypertension, diabetes mellitus, dyslipidemia, and high-sensitivity C-reactive protein; Stratified variables (sex, age, obesity, and diabetes mellitus) were omitted from the adjusted variables during the respective subgroup analyses. OR: Odds ratio; 95%CI: 95% confidence interval; Q: Quartile.

Table 4 Association between muscle strength and probable liver fibrosis assessed using fibrosis-4 among patients with metabolic dysfunction-associated fatty liver disease

Muscle strength	OR (95%CI)
	Model 1	Model 2	Model 3
1.3 ≤ FIB-4 < 2.67
Q1	2.67 (2.35–3.02)	0.96 (0.82–1.12)	1.03 (0.87–1.21)
Q2–Q4	1 (reference)	1 (reference)	1 (reference)
P value	< 0.001	0.588	0.773
Q1	4.09 (3.50–4.79)	0.89 (0.72–1.09)	1.01 (0.81–1.26)
Q2	2.31 (2.00–2.66)	0.85 (0.71–1.01)	0.94 (0.78–1.13)
Q3	1.67 (1.43–1.94)	0.97 (0.81–1.16)	1.04 (0.86–1.25)
Q4	1 (reference)	1 (reference)	1 (reference)
P for trend	< 0.001	0.117	0.809
FIB-4 ≥ 2.67
Q1	4.71 (3.38–6.56)	1.72 (1.19–2.50)	1.83 (1.25–2.69)
Q2–Q4	1 (reference)	1 (reference)	1 (reference)
P value	< 0.001	0.004	0.002
Q1	8.13 (4.74–13.95)	1.68 (0.89–3.17)	1.85 (0.92–3.74)
Q2	2.25 (1.22–4.15)	0.78 (0.41–1.47)	0.82 (0.41–1.66)
Q3	2.20 (1.18–4.13)	1.26 (0.65–2.46)	1.31 (0.65–2.65)
Q4	1 (reference)	1 (reference)	1 (reference)
P for trend	< 0.001	0.113	0.073

Odds ratios (95% confidence intervals) were calculated using multivariable logistic regression analysis; Model 1 = not adjusted; Model 2 = adjusted for age, sex, income, education, smoking status, and physical activity; Model 3 = Model 2 + alanine aminotransferase, obesity, hypertension, diabetes mellitus, dyslipidemia, and high-sensitivity C-reactive protein. OR: Odds ratio; 95%CI: 95% confidence interval; FIB-4: Fibrosis-4; Q: Quartile.