Background and aims: Nonalcoholic fatty liver disease (NAFLD) and sarcopenic obesity share several pathophysiologic backgrounds. No prior studies have determined a plausible association between sarcopenic obesity and NAFLD and NAFLD-associated fibrosis. We aim to investigate the association between sarcopenic obesity and NAFLD, and NAFLD-associated fibrosis detected by transient elastography.
Methods: In a cross-sectional study from the 2017-2018 National Health and Nutrition Examination Survey, 1,925 participants were identified. NAFLD was defined by controlled attenuation parameter (CAP) scores and significant fibrosis (≥F2)/cirrhosis by liver stiffness measurements on transient elastography. Sarcopenic obesity was defined by appendicular lean mass and body fat.
Results: Individuals with sarcopenic obesity had a significantly higher odds of having NAFLD [CAP score ≥263 dB/m, odds ratio (OR): 2.88, 95% confidence interval (CI): 1.82-4.57, and CAP score ≥285, OR: 3.71, 95%CI: 2.24-6.14] after adjusting for age, gender, and race/ethnicity. The association remained statistically significant after adjustment for socioeconomic status, lifestyle and behavioral risk factors, and metabolic conditions (CAP score ≥263, OR: 2.61, 95%CI: 1.51-4.50, and CAP score ≥285, OR: 3.31, 95%CI: 1.85-5.96). Sarcopenic obesity was also associated with higher odds of having NAFLD-associated significant fibrosis (OR 2.22, 95% CI: 1.03-4.80) in the multivariate model. While those with sarcopenic obesity had a higher prevalence of NAFLD-associated cirrhosis, this association did not reach statistical significance.
Conclusions: Sarcopenic obesity was independently associated with an increased risk of NAFLD and NAFLD- associated significant fibrosis independent of well-defined risk factors. Targeted interventions to improve sarcopenic obesity may reduce the risk of NAFLD and NAFLD-associated siginificant fibrosis.