Diabetes Metab J.  2023 Mar;47(2):232-241. 10.4093/dmj.2021.0355.

Non-Alcoholic Fatty Liver Disease with Sarcopenia and Carotid Plaque Progression Risk in Patients with Type 2 Diabetes Mellitus

• Cho Y
• Park HS
• Huh BW
• Lee Yh
• Seo SH
• Seo DH
• Ahn SH
• Hong S
• Kim SH

• KMID: 2540520
• DOI: http://doi.org/10.4093/dmj.2021.0355

Abstract

Background
We aimed to evaluate whether non-alcoholic fatty liver disease (NAFLD) with or without sarcopenia is associated with progression of carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM).
Methods
We investigated 852 T2DM patients who underwent abdominal ultrasonography, bioelectrical impedance analysis, and carotid artery ultrasonography at baseline and repeated carotid ultrasonography after 6 to 8 years. NAFLD was confirmed by abdominal ultrasonography, and sarcopenia was defined as a sex-specific skeletal muscle mass index (SMI) value <2 standard deviations below the mean for healthy young adults. SMI was calculated by dividing the sum of appendicular skeletal mass by body weight. We investigated the association between NAFLD with or without sarcopenia and the progression of carotid atherosclerosis.
Results
Of the 852 patients, 333 (39.1%) were classified as NAFLD without sarcopenia, 66 (7.7%) were classified as sarcopenia without NAFLD, and 123 (14.4%) had NAFLD with sarcopenia at baseline. After 6 to 8 years, patients with both NAFLD and sarcopenia had a higher risk of atherosclerosis progression (adjusted odds ratio, 2.20; P<0.009) than controls without NAFLD and sarcopenia. When a subgroup analysis was performed on only patients with NAFLD, female sex, absence of central obesity, and non-obesity were significant factors related to increased risk of plaque progression risk in sarcopenic patients.
Conclusion
NAFLD with sarcopenia was significantly associated with the progression of carotid atherosclerosis in T2DM patients.

Keyword

Atherosclerosis; Diabetes mellitus, type 2; Fatty liver; Sarcopenia

Figure

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  Fig. 1. Prevalence of sarcopenia in study participants, grouped according to the presence of hepatic steatosis. (A) Sarcopeniaweight was defined as skeletal muscle mass index (SMI, %) <2 standard deviations below the gender-specific mean for healthy young adults in the Korean population: SMI (%) <29.0 in men and <22.9 in women was considered as sarcopenia. (B) Sarcopeniaheight was defined as an appendicular skeletal mass/height2 ratio <7.0 in men and <5.7 in women. NAFLD, non-alcoholic fatty liver disease.

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  Fig. 2. Odds ratio of carotid plaque progression by subgroups. Risk of carotid plaque progression according to the presence of sarcopenia in participants with non-alcoholic fatty liver disease (NAFLD) stratified by age (≥60 years), sex, diabetes mellitus (DM) duration (≥6 years, study median), central obesity (waist circumference ≥90 cm for men and ≥85 cm for women), and body mass index (BMI; ≥25 kg/m2). CI, confidence interval.

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