Sarcopenia as a Risk Factor for Mortality in NAFLD: How Should We Diagnose It?

Area of Science:

• Hepatology
• Geriatrics
• Metabolic Diseases

Background:

• Sarcopenia is a risk factor for nonalcoholic steatohepatitis (NASH) and cirrhosis in patients with nonalcoholic fatty liver disease (NAFLD).
• Lifestyle interventions are effective for both NAFLD and sarcopenia, but sarcopenia diagnosis in NAFLD patients is not well-defined.
• Poorly managed NAFLD can lead to adverse health outcomes.

Purpose of the Study:

• To examine current diagnostic methods for sarcopenia in patients with nonalcoholic fatty liver disease (NAFLD).

Main Methods:

• A systematic review of MEDLINE, EMBASE, and CINAHL databases was conducted for articles published until July 2023.
• Search terms included "Non-alcoholic fatty liver disease," "NAFLD," "fatty liver," "sarcopenia," and "myoatrophy."
• Studies were excluded based on pediatric populations, lack of both NAFLD and sarcopenia diagnosis, or alternative causes of liver disease.

Main Results:

• Twenty studies involving 68,848 participants were included, predominantly from Asian countries.
• Heterogeneity was observed in NAFLD diagnostic tools (most commonly abdominal ultrasound) and sarcopenia definitions across different working groups.
• Muscle mass was universally measured (often via bioelectrical impedance analysis), while muscle strength (hand grip) and function (gait speed, timed up-and-go) were assessed less frequently.

Conclusions:

• A significant lack of standardization exists in diagnosing sarcopenia among NAFLD patients.
• Establishing a consistent definition for sarcopenia in this population is crucial.
• Standardization will help prevent overlooking this comorbidity, thereby improving patient care and outcomes.