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Skeletal muscle mass to visceral fat area ratio as a predictor of NAFLD in lean and overweight men and women with effect modification by sex

Skeletal muscle mass to visceral fat area ratio as a predictor of NAFLD in lean and overweight men and women with effect modification by sex
Skeletal muscle mass to visceral fat area ratio as a predictor of NAFLD in lean and overweight men and women with effect modification by sex

The effect of sarcopenic visceral obesity on the risk of nonalcoholic fatty liver disease (NAFLD) is uncertain. We investigated (a) whether the skeletal muscle mass to visceral fat area ratio (SV ratio), as a measure of sarcopenic visceral obesity, is a risk factor for NAFLD; and (b) whether the SV ratio adds to conventional adiposity measures to improve prediction of incident NAFLD. Adults without NAFLD (n = 151,017) were followed up for a median of 3.7 years. Hepatic steatosis was measured using ultrasonography, and liver fibrosis scores were estimated using the Fibrosis-4 index (FIB-4) and the NAFLD Fibrosis Score (NFS). Cox proportional hazards models were used to determine sex-specific adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]). The incremental predictive performance was assessed using the area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Multivariable aHRs (95% CIs) for incident NAFLD comparing the lowest versus the highest quintile of SV ratio were 3.77 (3.56–3.99) for men and 11.69 (10.46–13.06) for women (p–interaction by sex < 0.001). For incident NAFLD with intermediate/high FIB-4, aHRs were 2.83 (2.19–3.64) for men and 7.96 (3.85–16.44) for women (similar results were obtained for NFS). Associations remained significant even after adjustment for body mass index, waist circumference, and time-varying covariates. These associations were also more pronounced in nonobese than obese participants (p–interaction < 0.001). The addition of SV ratio to conventional adiposity measures modestly improved risk prediction for incident NAFLD. SV ratio was inversely associated with risk of developing NAFLD, with effect modification by sex and obesity. Conclusion: Low SV ratio is a complementary index to conventional adiposity measures in the evaluation of NAFLD risk.

2238-2252
Cho, Yoosun
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Chang, Yoosoo
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Ryu, Seungho
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Jung, Hyun-Suk
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Kim, Chan-won
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Oh, Hyungseok
bd8be3bd-512a-4c1f-9536-55054e0a93cf
Kim, Mi Kyung
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Sohn, Won
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Shin, Hocheol
ec7ba000-4519-4d9e-8840-4dcd38d979d3
Wild, Sarah H.
f82bc0b5-0175-472c-bd95-d7d9c8ab6cdf
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c
Cho, Yoosun
5e4be363-4c9a-481c-9151-0ff923d60775
Chang, Yoosoo
7b8aa145-37bc-44ae-b961-d72fec3788de
Ryu, Seungho
d56302bc-da51-412e-9e48-2c9f9728f453
Jung, Hyun-Suk
9f138367-4ea7-4da0-a8a4-6bfba4d7b1ea
Kim, Chan-won
83c2db37-d139-49bb-b581-e6daad050d0b
Oh, Hyungseok
bd8be3bd-512a-4c1f-9536-55054e0a93cf
Kim, Mi Kyung
0ed4f64f-43fa-43e8-a18f-a45ea4fb7e3a
Sohn, Won
307c0e12-05f3-4993-a81c-704f81f3c564
Shin, Hocheol
ec7ba000-4519-4d9e-8840-4dcd38d979d3
Wild, Sarah H.
f82bc0b5-0175-472c-bd95-d7d9c8ab6cdf
Byrne, Christopher
1370b997-cead-4229-83a7-53301ed2a43c

Cho, Yoosun, Chang, Yoosoo, Ryu, Seungho, Jung, Hyun-Suk, Kim, Chan-won, Oh, Hyungseok, Kim, Mi Kyung, Sohn, Won, Shin, Hocheol, Wild, Sarah H. and Byrne, Christopher (2022) Skeletal muscle mass to visceral fat area ratio as a predictor of NAFLD in lean and overweight men and women with effect modification by sex. Hepatology Communications, 6 (9), 2238-2252. (doi:10.1002/hep4.1975).

Record type: Article

Abstract

The effect of sarcopenic visceral obesity on the risk of nonalcoholic fatty liver disease (NAFLD) is uncertain. We investigated (a) whether the skeletal muscle mass to visceral fat area ratio (SV ratio), as a measure of sarcopenic visceral obesity, is a risk factor for NAFLD; and (b) whether the SV ratio adds to conventional adiposity measures to improve prediction of incident NAFLD. Adults without NAFLD (n = 151,017) were followed up for a median of 3.7 years. Hepatic steatosis was measured using ultrasonography, and liver fibrosis scores were estimated using the Fibrosis-4 index (FIB-4) and the NAFLD Fibrosis Score (NFS). Cox proportional hazards models were used to determine sex-specific adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]). The incremental predictive performance was assessed using the area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Multivariable aHRs (95% CIs) for incident NAFLD comparing the lowest versus the highest quintile of SV ratio were 3.77 (3.56–3.99) for men and 11.69 (10.46–13.06) for women (p–interaction by sex < 0.001). For incident NAFLD with intermediate/high FIB-4, aHRs were 2.83 (2.19–3.64) for men and 7.96 (3.85–16.44) for women (similar results were obtained for NFS). Associations remained significant even after adjustment for body mass index, waist circumference, and time-varying covariates. These associations were also more pronounced in nonobese than obese participants (p–interaction < 0.001). The addition of SV ratio to conventional adiposity measures modestly improved risk prediction for incident NAFLD. SV ratio was inversely associated with risk of developing NAFLD, with effect modification by sex and obesity. Conclusion: Low SV ratio is a complementary index to conventional adiposity measures in the evaluation of NAFLD risk.

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Accepted/In Press date: 4 April 2022
e-pub ahead of print date: 3 May 2022
Published date: 3 May 2022
Additional Information: Funding Information: We thank our staff members at the Kangbuk Samsung Health Study for their hard work, dedication, and continuing support. This study was supported by the SKKU Excellence in Research Award Research Fund, Sungkyunkwan University, 2020, and by the National Research Foundation of Korea, funded by the Ministry of Science, ICT & Future Planning (NRF‐2021R1A2C1012626). CDB is supported in part by the Southampton National Institute for Health Research Biomedical Research Center (IS‐BRC‐20004), UK. Publisher Copyright: © 2022 The Authors. Hepatology Communications published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.

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Local EPrints ID: 456749
URI: http://eprints.soton.ac.uk/id/eprint/456749
PURE UUID: 0401db9e-6781-40c8-819b-c7215fef2760
ORCID for Christopher Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 10 May 2022 16:46
Last modified: 03 Sep 2022 01:38

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Contributors

Author: Yoosun Cho
Author: Yoosoo Chang
Author: Seungho Ryu
Author: Hyun-Suk Jung
Author: Chan-won Kim
Author: Hyungseok Oh
Author: Mi Kyung Kim
Author: Won Sohn
Author: Hocheol Shin
Author: Sarah H. Wild

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