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Risk Stratification for Sarcopenic Obesity in Subjects With Nonalcoholic Fatty Liver Disease

 Ho Soo Chun  ;  Minjong Lee  ;  Hye Ah Lee  ;  Sejin Lee  ;  Soyeon Kim  ;  Ye Jun Jung  ;  Chaewon Lee  ;  Hyoeun Kim  ;  Han Ah Lee  ;  Hwi Young Kim  ;  Kwon Yoo  ;  Tae Hun Kim  ;  Sang Hoon Ahn  ;  Seung Up Kim 
 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, Vol.21(9) : 2298-2307 e18, 2023-08 
Journal Title
Issue Date
Cardiovascular Diseases* / epidemiology ; Cross-Sectional Studies ; Humans ; Liver Cirrhosis / complications ; Liver Cirrhosis / diagnosis ; Liver Cirrhosis / epidemiology ; Male ; Non-alcoholic Fatty Liver Disease* / complications ; Non-alcoholic Fatty Liver Disease* / diagnosis ; Non-alcoholic Fatty Liver Disease* / epidemiology ; Obesity / complications ; Obesity / epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sarcopenia* / complications ; Sarcopenia* / epidemiology
Cardiovascular Disease ; Liver Fibrosis ; Nonalcoholic Fatty Liver Disease ; Risk Stratification ; Sarcopenic Obesity
Background & aims: The impact of the severity of sarcopenic obesity (SO) in nonalcoholic fatty liver disease (NAFLD) on the risk of significant liver fibrosis or cardiovascular disease (CVD) remains unclear. We aimed to identify high-risk subjects with SO for significant liver fibrosis or CVD among subjects with SO and NAFLD.

Methods: This multicenter, retrospective study involved 23,889 subjects with NAFLD who underwent a health screening program (2014-2020). Sarcopenia was defined based on gender-specific sarcopenia index cutoff using multi-frequency bioelectric impedance analysis. High-risk subjects with SO were defined as those with significant liver fibrosis by fibrosis-4 index >2.67 or atherosclerotic CVD risk score >20%. Multivariable logistic regression analysis for identifying high-risk subjects with SO was performed in a cross-sectional cohort with SO, and further validation was performed in a longitudinal cohort.

Results: SO prevalence was 5.4% (n = 1297 of 23,889). Older age (unstandardized beta [β] = 3.23; P < .001), male (β = 1.66; P = .027), sarcopenia index (β = -6.25; P = .019), and metabolic syndrome (β = 1.75; P < .001) were significant risk factors for high-risk SO. Based on a high-risk SO screening model, high-risk subjects with SO had significantly higher odds of significant liver fibrosis (training: adjusted odds ratio [aOR], 3.72; validation: aOR, 2.38) or CVD (training: aOR, 5.20; validation: aOR, 3.71) than subjects without SO (all P < .001). In subgroup analyses, the cumulative incidence of significant liver fibrosis or CVD development was significantly higher in high-risk subjects with SO than in low-risk subjects with SO in a longitudinal cohort considering all-cause mortality and liver transplantation as competing risks (sub-distribution hazard ratio, 5.37; P < .001).

Conclusion: The high-risk screening model may enable the identification of high-risk subjects with SO with NAFLD.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Kim, Hyoeun(김효은) ORCID logo https://orcid.org/0000-0002-7334-9700
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
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