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. 2020 May 7:15:1005-1014.
doi: 10.2147/COPD.S249534. eCollection 2020.

Sarcopenia Is an Independent Risk Factor for NAFLD in COPD: A Nationwide Survey (KNHANES 2008-2011)

Kyung Soo Hong  1 , Min Cheol Kim  2 , June Hong Ahn  1
Affiliations

Sarcopenia Is an Independent Risk Factor for NAFLD in COPD: A Nationwide Survey (KNHANES 2008-2011)

Kyung Soo Hong et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and is independently associated with cardiometabolic comorbidities and systemic inflammation. Although several factors are associated with NAFLD, the influence of sarcopenia on NAFLD has not been fully determined in patients with COPD. We explored whether sarcopenia is associated with NAFLD in a COPD population.

Methods: Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analyzed. The subjects were defined as having NAFLD when they had a hepatic steatosis index (HSI) score >36, which is a previously validated NAFLD prediction score. Sarcopenia_BMI (=total appendicular skeletal muscle mass [kg]/body mass index [kg/m2]), sarcopenia_BW (=total appendicular skeletal muscle mass [kg]/body weight [kg] × 100), and sarcopenia_height (= total appendicular skeletal muscle mass (kg)/height2 (m)) measured using dual-energy X-ray absorptiometry was used to diagnose sarcopenia.

Results: NAFLD was identified in 124 (14.6%) of 850 COPD subjects using the HSI. Multivariable logistic analyses adjusted for age, sex, hypertension, diabetes mellitus (DM), forced vital capacity (FVC), and metabolic syndrome demonstrated that sarcopenia (sarcopenia_BMI, odds ratio [OR] = 1.95; 95% confidence interval [CI], 1.11-3.46, p = 0.022; sarcopenia_BW, OR = 2.25; 95% CI, 1.30-3.92, p = 0.004) was associated with NAFLD in patients with COPD. The proportion of sarcopenia_BMI was higher in patients with a high fibrotic burden from NAFLD (Q3, Q4) than in subjects with a low fibrotic burden from NALFD (Q1, Q2) (54.8% vs 24.2%, p = 0.024). The proportion of sarcopenia_BW was also higher in patients with a high fibrotic burden from NAFLD than in patients with a low fibrotic burden from NAFLD (51.6% vs 30.6%, p = 0.029).

Conclusion: Sarcopenia was associated with an increased risk for NAFLD in patients with COPD, independent of age, sex, lung function, and metabolic factors. Sarcopenic COPD was also associated with a high fibrotic burden in NAFLD patients. Pulmonologists should be aware of possible liver comorbidities in the sarcopenic COPD phenotype.

Keywords: COPD; NAFLD; sarcopenia.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
A flow diagram of the study subjects in the KNHANES IV and V (2008–2011). Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; COPD, chronic obstructive pulmonary disease; DXA, dual-energy X-ray absorptiometry; HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease.
Figure 2
Figure 2
Prevalence of NAFLD in patients with COPD based on the GOLD grade. (A) GOLD I, II, III, and IV; (B) GOLD I, and II–IV. Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease; NAFLD, nonalcoholic fatty liver disease.
Figure 3
Figure 3
Association between sarcopenia and fibrotic burden in NAFLD patients (n = 124) according to the definitions of sarcopenia. (A) Sarcopenia_BMI; (B) sarcopenia_BW. Abbreviations: BMI, body mass index; BW, body weight; NAFLD, nonalcoholic fatty liver disease; NFS, NAFLD fibrosis score.
See this image and copyright information in PMC

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