Association between Body Composition Contents and Hepatic Fibrosis in Sarcopenic Obesity

Abstract

It is well established that sarcopenic obesity (SO) is linked to many diseases such as metabolic and non-alcoholic fatty liver diseases, but there is little known about the relationship between SO and hepatic fibrosis progression in chronic liver disease. This study compared body composition contents in patients with non-obesity (NOb) and SO using abdominal magnetic resonance imaging and investigated the relationship between hepatic fibrosis and SO factors. This retrospective study enrolled 60 patients (28 NOb; 32 SO) from June 2014 to December 2020. Patients underwent histopathologic investigation where they classified fibrosis stages based on the Meta-analysis of Histological Data in Viral Hepatitis fibrosis scoring system. Muscle and fat areas at the third lumber vertebra level were assessed. The variation in the areas of muscle (MA), subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) among fibrosis stages, and associations between hepatic fibrosis and SO factors, were analyzed. There were significant differences in SAT and VAT (p < 0.001), whereas there was no difference in MA (p = 0.064). There were significant differences in MA/SAT (p = 0.009), MA/VAT (p < 0.001), and MA/(SAT+VAT) (p < 0.001). In all the patients, hepatic fibrosis positively correlated with serum aspartate aminotransferase level (AST, R = 0.324; p = 0.025). Especially in SO patients, hepatic fibrosis closely correlated with body mass index (BMI, R = 0.443; p = 0.011), AST (R = 0.415; p = 0.044), VAT (R = 0.653; p < 0.001), MA/VAT (R = -0.605; p < 0.001), and MA/(SAT+VAT) (R = -0.416; p = 0.018). However, there was no association in NOb patients. This study demonstrated that SO patients had larger SAT and VAT than NOb patients. Hepatic fibrosis in SO positively correlated with body visceral fat composition in combination with BMI and AST level. These findings will be useful for understanding the relationship between the hepatic manifestation of fibrosis and body fat composition in sarcopenia and SO.

Keywords: body composition; hepatic fibrosis; sarcopenic obesity (SO); third lumber spine (L3).

Figure 1

Flowcharts of the study population for inclusion. BMI: body mass index; EMR: electronic medical records; METAVIR: meta-analysis virus hepatitis histological scoring system; PACS: picture archiving and communication system.

Figure 2

Hepatic fibrosis classification based on the Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) fibrosis scoring system (liver inside red line on the upper panel) and representative measurement of body composition contents (muscle, subcutaneous adipose tissue, and visceral adipose tissue) from abdominal MR scans at third lumbar vertebra level (L3, lower panel). The graphic user interface (GUI) of the developed software “sarcopenia plug-in” including ImageJ platform basic menu bar, sarcopenia plug-in window (left in the lower panel), and region of interest (ROI) manager window (right in the lower panel). An example demonstrating the ROI extraction for quantifying muscle area (red area), subcutaneous adipose tissue (blue area), and visceral adipose tissue (yellow area) mass in a patient with sarcopenic obesity using “sarcopenia plug-in”. The original ImageJ software (ver.1.51t, Java 1.8.0_191 64 bits; the National Institutes of Health (NIH), Bethesda, MD, USA) is available at https://imagej.nih.gov/ij/, accessed on 31 December 2017.

Figure 3

Box plots of the areas of muscle (MA, (A)), subcutaneous adipose tissue (SAT, (B)), and visceral adipose tissue (VAT, (C)), and the ratios of MA/SAT (D), MA/VAT (E), and MA/(SAT+VAT) (F) in non-obesity (NOb) and sarcopenic obesity (SO) groups. Note that asterisks indicate significant differences between NOb and SO according to fibrosis stage as follows: ** p < 0.01, and *** p < 0.001.

Figure 4

Correlation plots between the pathologic METAVIR scores and other factors. Graphs showing close correlations between AST level and fibrosis stage (F) in all patients (linear polynomial correlation R = 0.324; p = 0.025) (A), and between AST level and F (R = 0.415; p = 0.044) (B), between BMI and F (R = 0.443; p = 0.011) (C), between visceral adipose tissue (VAT) and F (R = 0.653; p < 0.001) (D), between MA/VAT ratio and F (R = −0.605; p < 0.001) (E), and MA/(SAT+VAT) ratio and F (R = −0.416; p = 0.018) (F) within only SO group, respectively. The dashed line in each plot indicates the 95% confidence interval line.