Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Apr 22, 2024; 15(1): 91100
Published online Apr 22, 2024. doi: 10.4291/wjgp.v15.i1.91100
Prevalence and outcome of sarcopenia in non-alcoholic fatty liver disease
Suprabhat Giri, Prajna Anirvan, Sumaswi Angadi, Ankita Singh, Anurag Lavekar
Suprabhat Giri, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Prajna Anirvan, Department of Gastroenterology, Kalinga Gastroenterology Foundation, Cuttack, 753001, Odisha, India
Sumaswi Angadi, Department of Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad 500082, Telangana, India
Ankita Singh, Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India
Anurag Lavekar, Department of Gastroenterology, Sagar Hospital, Bengaluru 560041, Karnataka, India
Author contributions: Giri S and Lavekar A contributed to the conception and design of the manuscript; Giri S, Angadi S, and Singh A contributed to the literature review, analysis, data collection, and interpretation; Giri S, Anirvan P, and Angadi S drafted the initial manuscript; Giri S and Lavekar A contributed to the critical revision of the initial manuscript; and all the authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2021 Checklist, and the manuscript was prepared and revised according to the PRISMA 2021 Checklist.
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: Anurag Lavekar, MD, Consultant Gastroenterologist, Department of Gastroenterology, Sagar Hospital, No. 44/54, 30th Cross Road, Extension, 4th T Block East, Tilak Nagar, Jayanagar, Bengaluru 560041, Karnataka, India. anuraglavekar@gmail.com
Received: December 21, 2023
Revised: February 9, 2024
Accepted: April 1, 2024
Published online: April 22, 2024
Processing time: 119 Days and 11.2 Hours
Abstract
BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) includes a spectrum of conditions, progressing from mild steatosis to advanced fibrosis. Sarcopenia, characterized by decreased muscle strength and mass, shares common pathophysiological traits with NAFLD. An association exists between sarcopenia and increased NAFLD prevalence. However, data on the prevalence of sarcopenia in NAFLD and its impact on the outcomes of NAFLD remain inconsistent.

AIM

To analyze the prevalence and outcomes of sarcopenia in patients with NAFLD.

METHODS

We conducted a comprehensive search for relevant studies in MEDLINE, Embase, and Scopus from their inception to June 2023. We included studies that focused on patients with NAFLD, reported the prevalence of sarcopenia as the primary outcome, and examined secondary outcomes, such as liver fibrosis and other adverse events. We also used the Newcastle-Ottawa scale for quality assessment.

RESULTS

Of the 29 studies included, the prevalence of sarcopenia in NAFLD varied widely (1.6% to 63.0%), with 20 studies reporting a prevalence of more than 10.0%. Substantial heterogeneity was noted in the measurement modalities for sarcopenia. Sarcopenia was associated with a higher risk of advanced fibrosis (odd ratio: 1.97, 95% confidence interval: 1.44-2.70). Increased odds were consistently observed in fibrosis assessment through biopsy, NAFLD fibrosis score/body mass index, aspartate aminotransferase to alanine aminotransferase ratio, diabetes (BARD) score, and transient elastography, whereas the fibrosis-4 score showed no such association. Sarcopenia in NAFLD was associated with a higher risk of steatohepatitis, insulin resistance, cardiovascular risks, and mortality.

CONCLUSION

This systematic review highlights the critical need for standardized diagnostic criteria and measurement methods for sarcopenia in NAFLD patients. The variability in study designs and assessment methods for sarcopenia and liver fibrosis may account for the inconsistent findings. This review demonstrates the multidimensional impact of sarcopenia on NAFLD, indicating its importance beyond liver-related events to include cardiovascular risks, mortality, and metabolic complications.

Keywords: Non-alcoholic fatty liver disease; Sarcopenia; Hepatic fibrosis; Low muscle mass; Hand grip strength; Bioelectric impedance analysis; Dual X-ray absorptiometry

Core Tip: The prevalence of sarcopenia in nonalcoholic fatty liver disease (NAFLD) varies widely. Sarcopenia in NAFLD is consistently associated with a higher risk of advanced fibrosis. In addition to liver-related events, sarcopenia in NAFLD is associated with adverse outcomes, including an increased risk of nonalcoholic steatohepatitis, mortality, cardiovascular risks, and metabolic complications. The heterogeneity in prevalence and associations highlights the importance of accurately defining measurement modalities and cutoff criteria. Establishing consensus guidelines is crucial for advancing research and enhancing clinical management in the complex relationship between sarcopenia and NAFLD.