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. 2021 Aug 3;10(15):3445.
doi: 10.3390/jcm10153445.

Association of Body Composition and Sarcopenia with NASH in Obese Patients

Sophia Marie-Therese Schmitz  1 , Lena Schooren  1 , Andreas Kroh  1 , Alexander Koch  2 , Christine Stier  3 , Ulf Peter Neumann  1   4 , Tom Florian Ulmer  1   4 , Patrick Hamid Alizai  1
Affiliations

Association of Body Composition and Sarcopenia with NASH in Obese Patients

Sophia Marie-Therese Schmitz et al. J Clin Med. .

Abstract

Obese patients often suffer from sarcopenia or sarcopenic obesity (SO) that can trigger inflammatory diseases including non-alcoholic steatohepatitis (NASH). Sarcopenia and SO can be diagnosed through measuring parameters of body composition such as skeletal muscle mass (SMM), skeletal muscle index (SMI) and fat mass (FM) obtained by bioelectrical impedance analysis (BIA). The aim of this study was to assess the relationship of body composition and NASH in patients with obesity. A total of 138 patients with obesity that underwent bariatric surgery were included in this study. BIA was used to estimate body composition. A liver biopsy was taken intraoperatively and histological assessment of NASH was performed. A total of 23 patients (17%) were classified as NASH and 65 patients (47%) met the criteria for borderline NASH. Body mass index (BMI) was significantly higher in patients with NASH compared to borderline NASH and no NASH (56.3 kg/m2 vs. 51.6 kg/m2 vs. 48.6 kg/m2, p = 0.004). Concerning body composition, FM, but also SMM and SMI were significantly higher in patients with NASH (p-values 0.011, 0.005 and 0.006, resp.). Fat mass index (FMI) and weight-adjusted skeletal muscle index (SMI_weight) failed to reach statistical significance (p-values 0.067 and 0.661). In patients with obesity, higher FM were associated with NASH. Contrary to expectations, SMM and SMI were also higher in patients with NASH. Therefore, higher body fat, rather than sarcopenia and SO, might be decisive for development of NASH in patients with obesity.

Keywords: BIA; NAFLD; NASH; bioelectrical impedance analysis; body composition.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Body mass index (BMI) according to NAS classification, data indicated as mean (SEM), ** p = 0.0025, Abbreviations: BMI: body mass index, NASH non-alcoholic steatohepatitis.
Figure 2
Figure 2
Fat mass and fat-free mass according to NAS subclasses. Data indicated as mean (SEM). Adjusted p-values * p = 0.0237, ** p = 0.0042 (Tukey’s multiple comparisons test). Abbreviations: FFM: fat-free mass; FM: fat mass; NASH: non-alcoholic steatohepatitis.
Figure 3
Figure 3
Skeletal muscle mass and total body weight showed a significant correlation, r = 0.701, p < 0.0001. Abbreviations: SMM: skeletal muscle mass, TBW: total body weight.
Figure 4
Figure 4
Skeletal muscle index and total body weight showed a significant correlation, r = 0.664, p < 0.0001). Abbreviations: SMI: skeletal muscle index, TBW: total body weight.
Figure 5
Figure 5
NAS classes according to presence of sarcopenic obesity (SO), defined by the lowest tertile in weight-adjusted SMI. (χ2, p = 0.8847). Abbreviations: NASH: non-alcoholic steatohepatitis, SO: sarcopenic obesity.
Figure 6
Figure 6
Skeletal muscle index and HOMA-IR showed a weak but significant correlation, r = 0.252, p = 0.016). Abbreviations: SMI: skeletal muscle index, HOMA-IR: homeostasis model assessment—insulin resistance.
Figure 7
Figure 7
Weight-adjusted skeletal muscle index and HOMA-IR showed no significant correlation, r = −0.09, p = 0.386). Abbreviations: SMI: skeletal muscle index, HOMA: homeostasis model assessment—insulin resistance.
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