Impact of non-alcoholic fatty liver disease on the risk of sarcopenia: a nationwide multicenter prospective study

Eun Roh, Soon Young Hwang, Hye Jin Yoo, Sei Hyun Baik, Jin Hee Lee, Sang Joon Son, Hyeon Ju Kim, Yong Soon Park, Sam Gyu Lee, Be Long Cho, Hak Chul Jang, Bong Jo Kim, Miji Kim, Chang Won Won, Kyung Mook Choi

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Background and aims: Despite the association between sarcopenia and non-alcoholic fatty liver disease (NAFLD), no study has evaluated the predictive role of NAFLD in sarcopenia. We investigated impact of NAFLD on the risk of low muscle mass (LMM) and low muscle strength (LMS) in a nationwide multicenter study. Methods: A total of 1595 community-dwelling people aged 70–84 years were followed for 2 years in the Korean Frailty and Aging Cohort Study. Muscle mass was estimated by dividing appendicular skeletal muscle mass (ASM) by body mass index (BMI). Muscle strength was measured as handgrip strength (HGS) divided by BMI. The sex-specific lowest quintiles of ASM/BMI and HGS/BMI of the study population were used as cutoffs for LMM and LMS, respectively. The risk of LMM and LMS were assessed according to hepatic steatosis index (HSI) and fatty liver index (FLI) quartiles. Results: As HSI quartiles increased, the LMM risk increased gradually, after adjusting for age, sex, lifestyle factors, comorbidities, and several causative factors (insulin resistance, inflammation, and vitamin D) (Q4 vs. Q1 OR [95% CI] 3.46 [2.23–5.35]). The increased risk of LMS was even higher according to HSI quartiles (Q4 vs. Q1 5.81 [3.67–9.21]). Multivariate analyses based on FLI showed similar results. People with NAFLD (HSI > 36) were at higher risk of developing LMM and LMS compared to those without (1.65 [1.19–2.31] and 2.29 [1.61–3.26], respectively). Conclusions: The presence of NAFLD may predict future risk of LMM and LMS, with greater impact on LMS than on LMM. Graphic abstract: [Figure not available: see fulltext.]

Original languageEnglish
Pages (from-to)545-554
Number of pages10
JournalHepatology International
Issue number3
Publication statusPublished - 2022 Jun

Bibliographical note

Funding Information:
This study was supported by grant from the Korea Health Technology R&D Project through the Korean Health Industry Development Institute (KHIDI) funded by the Ministry of Health and Welfare of Korea (grant number: HI15C3153) and grant from the National Research Foundation of Korea (NRF) funded by the Ministry of Education of Korea (grant number: 2020R1I1A1A01070499) This work was also supported by Korea University Guro Hospital (Korea Research-Driven Hospital) and grant funded by Korea University Medicine (K2115701).

Publisher Copyright:
© 2021, Asian Pacific Association for the Study of the Liver.


  • Cohort
  • Muscle
  • Muscle strength
  • Nonalcoholic fatty liver disease
  • Sarcopenia
  • Skeletal

ASJC Scopus subject areas

  • Hepatology


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