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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Metabolic-associated fatty liver disease is associated with low muscle mass and strength in patients with chronic hepatitis B
Cecy Maria de Lima Santos, Matheus Duarte Brito, Pedro Alves Soares Vaz de Castro, Thais Pontello de Vries, Nataly Lopes Viana, Marta Paula Pereira Coelho, Olívio Brito Malheiro, Tatiana Bering, Maria Cristina Gonzalez, Rosângela Teixeira, Rodrigo Dias Cambraia, Gifone Aguiar Rocha, Luciana Diniz Silva
Cecy Maria de Lima Santos, Thais Pontello de Vries, Nataly Lopes Viana, Marta Paula Pereira Coelho, Rosângela Teixeira, Luciana Diniz Silva, Sciences Applied to Adult Health Care Post-Graduate Programme Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Cecy Maria de Lima Santos, Matheus Duarte Brito, Pedro Alves Soares Vaz de Castro, Thais Pontello de Vries, Nataly Lopes Viana, Rosângela Teixeira, Rodrigo Dias Cambraia, Luciana Diniz Silva, Outpatient Clinic of Viral Hepatitis, Instituto Alfa de Gastroenterologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Matheus Duarte Brito, Pedro Alves Soares Vaz de Castro, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Olívio Brito Malheiro, Department of Locomotor System, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Tatiana Bering, Department of Food and Nutrition, Universidade Federal de Mato Grosso, Cuiabá 78060-900, Mato Grosso, Brazil
Maria Cristina Gonzalez, Postgraduate Program in Health and Behaviour, Catholic University of Pelotas, Pelotas 96015-560, Rio Grande do Sul, Brazil
Gifone Aguiar Rocha, Laboratory of Research in Bacteriology, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Luciana Diniz Silva, Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Author contributions: All authors have made substantial contributions; Santos CML, Rocha GA, Silva LD, and Bering T designed the research (project conception, development of overall research plan, and study oversight); Santos CML, Malheiro OB, Brito MD, Castro PASV, Vries TP, Viana NL, Coelho MPP, and Cambraia RD conducted the research (data collection); Malheiro OB, Teixeira R, and Gonzalez MC provided essential materials for the research; Santos CML, Malheiro OB, Brito MD, Castro PASV, Vries TP, Viana NL, Coelho MPP, Cambraia RD, and Silva LD analysed the data or performed the statistical analysis; Santos CML, Rocha GA, and Silva LD wrote the paper; and Santos CML, Rocha GA, and Silva LD had primary responsibility for the final content; all authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.
Supported by the Fundação de Amparo à Pesquisa do Estado de Minas Gerais, No. APQ - 02320 - 18.
Institutional review board statement: The study was designed and conducted following the Declaration of Helsinki and was approved by the Ethics Committee of Federal University of Minas Gerais/UFMG (ETIC 0404.0.203.000 - 10; CAAE, 07761212.2.0000.5149).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors report no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: All 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: Luciana Diniz Silva, MD, Associate Professor, Sciences Applied to Adult Health Care Post-Graduate Programme Faculdade de Medicina, Universidade Federal de Minas Gerais, Av Alfredo Balena 190 s/245, Belo Horizonte 30130-100, Minas Gerais, Brazil. lucianadinizsilva@gmail.com
Received: June 5, 2022
Peer-review started: June 5, 2022
First decision: June 22, 2022
Revised: July 4, 2022
Accepted: August 15, 2022
Article in press: August 15, 2022
Published online: August 27, 2022
ARTICLE HIGHLIGHTS
Research background
Recently, the clinical significance of sarcopenia in hepatic disease has been increasingly recognised. However, in chronic hepatitis B patients, the factors linked to skeletal muscle abnormalities have scarcely been investigated. Among them, host and environmental factors, such as nutritional and metabolic characteristics, should be evaluated.
Research motivation
Sarcopenia was identified in 7.1%, 11.8%, and 21.9% of noncirrhotic, compensated cirrhotic (Child-Turcotte-Pugh A), and decompensated cirrhotic (Child-Turcotte-Pugh B/C) patients, respectively. More recently, Han and colleagues observed that sarcopenia was significantly associated with liver disease severity, especially among hepatitis B virus (HBV)-positive subgroups with obesity, insulin resistance, metabolic syndrome and liver steatosis.
Research objectives
To investigate the association between components of sarcopenia and demographic, clinical, lifestyle, nutritional, and biochemical variables in HBV-chronically infected patients.
Research methods
Dual-energy X-ray absorptiometry (DXA) was used to assess muscle mass by quantifying appendicular lean mass (ALM) adjusted for body mass index (ALMBMI). Muscle function was evaluated by hand grip strength (HGS) and the timed up and go test. Metabolic-associated fatty liver disease (MAFLD) was defined according to the criteria proposed by an international expert panel. A Body Shape Index and the International Physical Activity Questionnaire were used to assess central obesity and physical activity level, respectively.
Research results
This cross-sectional study included 105 chronic hepatitis B (CHB) outpatients followed at the tertiary care ambulatory centre (mean age, 48.5 ± 12.0 years; 58.1% males; 76.2% without cirrhosis; 23.8% with compensated cirrhosis). The DXA-derived fat mass percentage was inversely correlated with the ALMBMI (r = - 0.87) and HGS (r = - 0.63). In the multivariable analysis, MAFLD, sedentarism and central obesity were positively and independently associated with low ALMBMI. Central obesity was independently associated with low HGS. MAFLD and central obesity were independently associated with low HGS.
Research conclusions
Among patients with CHB, metabolic-associated fatty liver disease (MAFLD) and central obesity were associated with low muscle mass and strength. Metabolic and skeletal muscle abnormality appraisal should be encouraged among HBV-chronically infected individuals.
Research perspectives
Further large-scale case-control studies are needed to evaluate the role of MAFLD in HBV-chronically infected patients, including individuals with MAFLD but without CHB.
