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Muscle Mass Is Linked to Liver Disease Severity in Pediatric Nonalcoholic Fatty Liver Disease
Toshifumi Yodoshi1, Sarah Orkin1, Ana-Catalina Arce Clachar2
1Division of Gastroenterology, Hepatology, and Nutrition, University of Cincinnati College of Medicine, Cincinnati, OH.
Insights
Reduced muscle mass in children with non-alcoholic fatty liver disease (NAFLD) is linked to more severe liver steatosis. Further research should explore if increasing muscle mass can improve NAFLD outcomes in pediatric patients.
Area of Science:
- Pediatric Hepatology
- Non-alcoholic Fatty Liver Disease (NAFLD) Research
- Body Composition and Metabolic Health
Background:
- Non-alcoholic fatty liver disease (NAFLD) is a growing concern in pediatric populations.
- Understanding factors associated with NAFLD severity is crucial for effective management.
- Muscle mass is a key component of overall metabolic health, but its role in pediatric NAFLD is not fully elucidated.
Purpose of the Study:
- To investigate the association between muscle mass and liver disease severity in pediatric patients diagnosed with NAFLD.
- To determine if muscle mass, quantified by the total psoas muscle surface area index (tPMSA index), correlates with histological or imaging markers of hepatic steatosis.
Main Methods:
- Retrospective study of pediatric patients (<20 years) with NAFLD (2009-2018).
- Muscle mass assessed via MRI-based tPMSA index; liver steatosis evaluated by histology (NASH CRN criteria) and MRI-measured proton density fat fraction (PDFF).
- Multivariable regression analyses adjusted for age, sex, and Community Deprivation Index (CDI).
Main Results:
- A higher steatosis score was independently associated with a lower tPMSA index in children with NAFLD.
- Liver PDFF showed significant associations with tPMSA index, sex, and CDI.
- Liver stiffness measurements did not show a significant association with the tPMSA index.
Conclusions:
- The tPMSA index is independently associated with both imaging and histological indicators of hepatic steatosis severity in children.
- Future research should examine the causal relationship between muscle mass and steatosis.
- Investigating interventions to enhance muscle mass for reducing NAFLD severity in children is warranted.
Objective:
To investigate the association between muscle mass and liver disease severity in pediatric patients with non-alcoholic fatty liver disease (NAFLD).
Study Design:
This was a retrospective study of patients aged <20 years followed from 2009 to 2018. Muscle mass was estimated in all patients by measuring magnetic resonance imaging-based total psoas muscle surface area (tPMSA) and correcting for height (tPMSA index = tPMSA/height2). Two cohorts were studied, one with histological confirmation of NAFLD (n = 100) and the other with magnetic resonance imaging (MRI) evidence of hepatic steatosis (n = 236). Histology was scored using Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) criteria. MRI-measured proton density fat fraction (PDFF) and liver stiffness were collected. Demographic, clinical, and socioeconomic status (using a validated Community Deprivation Index [CDI]) were assessed as covariates. Univariate regression analyses, followed by multivariable regression analyses, were used to determine the relationships between tPMSA index and NAS, MRI-PDFF, and liver stiffness, adjusting for clinical, demographic, and CDI variables.
Results:
In the multivariable regression analyses, higher steatosis score was associated with a lower tPMSA index (OR, 0.73; 95% CI, 0.56-0.96) and younger age (OR, 0.84; 95% CI, 0.73-0.97). Liver PDFF was also significantly associated with the tPMSA index (P = .029), sex (P = .019), and CDI (P = .005). In contrast, liver stiffness was not associated with tPMSA in multivariable analyses.
Conclusions:
tPMSA index was independently associated with both imaging and histological features of hepatic steatosis severity in children. Future studies should directly explore the presence and directionality of causative links between muscle mass and steatosis, as well as whether interventions that enhance muscle mass can reduce disease severity in children with NAFLD.
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