少肌性肥胖合并脂肪性肝病的诊断与治疗

doi:10.3969/j.issn.1672-5069.2021.01.039

摘要/Abstract

摘要： 目的非酒精性脂肪性肝病(NAFLD)是所有种族的儿童和成人最常见的慢性肝病。肌肉减少症是指因持续骨骼肌量流失、强度和功能下降而引起的综合征。随着肌肉减少症的进展,体质量不断减少,脂肪含量则不断增加,从而形成少肌性肥胖。少肌性肥胖与NAFLD及其疾病进展有关。既往大多数研究已证实肌肉减少症与NAFLD的正相关关系,但肌肉减少症和NAFLD诊断方法的多样性导致研究结果的解读和应用困难。本文主要综述了少肌性肥胖对NAFLD的影响以及两者并存时的诊断和治疗策略。

关键词: 脂肪肝, 肌肉减少症, 肥胖, 肝纤维化

Abstract: Objective Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults all over the world. Sarcopenia is a syndrome caused by continuous loss of skeletal muscle mass, strength, and functions. As sarcopenia progresses, lean body mass may decrease while fat mass increases, resulting in sarcopenic obesity. Sarcopenic obesity is associated with NAFLD and its development. Although most of the previous studies have demonstrated the positive correlation between sarcopenia and NAFLD, the difference in diagnostic methods of sarcopenia and NAFLD leads to difficulties in interpretation and application. This review mainly discusses the impact of sarcopenic obesity on NAFLD and the diagnosis and treatment strategies when the two coexist.

Key words: Fatty liver, Sarcopenia, Obesity, Liver fibrosis

宋叶雨(综述), 范建高(审校). 少肌性肥胖合并脂肪性肝病的诊断与治疗[J]. 实用肝脏病杂志, 2021, 24(1): 149-152.

Song Yeyu, Fan Jiangao. Diagnosis and treatment of sarcopenic obesity with fatty liver disease[J]. Journal of Practical Hepatology, 2021, 24(1): 149-152.

参考文献

[1] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性病专家委员会. 非酒精性脂肪性肝病防治指南(2018更新版). 实用肝脏病杂志 2018,21:177-186.
[2] 薛芮, 范建高. 代谢相关脂肪性肝病新定义的国际专家共识简介. 实用肝脏病杂志 2020,23:S55-S58.
[3] Cruz‐Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia:European consensus on definition and diagnosis:Report of the European Working Group on Sarcopenia in Older People. Age Ageing,2010,39(4):412-423.
[4] Prado CM, Lieffers JR, McCargar LJ,et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts:a population-based study. Lancet Oncol,2008,9(7):629-635.
[5] De Fré CH, De Fré MA, Kwanten WJ, et al. Sarcopenia in patients with non-alcoholic fatty liver disease:is it a clinically significant entity? Obes Rev,2019,20(2):353-363.
[6] Rubbieri G, Mossello E, Di Bari M. Techniques for the diagnosis of sarcopenia. Clin Cases Miner Bone Metab,2014,11(3):181-184.
[7] Chen LK, Liu LK, Woo J, et al.Sarcopenia in Asia:consensus report of the Asian Working Group for Sarcopenia.J Am Med Dir Assoc,2014,15(2):95-101.
[8] Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol,1998,147(8):755-763.
[9] Studenski SA, Peters KW, Alley DE, et al. The FNIH sarcopenia project:rationale, study description, conference recommendations, and final estimates. J GerontolA Biol Sci Med Sci,2014,69(5):547-558.
[10] Koo BK, Kim D, Joo SK, et al. Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis.J Hepatol,2017,66(1):123-131.
[11] Seko Y, Mizuno N, Okishio S, et al. Clinical and pathological features of sarcopenia-related indices in patients with non-alcoholic fatty liver disease. Hepatol Res,2019,49(6):627-636.
[12] Oshida N, Shida T, Oh S,et al. Urinary levels of titin-N fragment, a skeletal muscle damage marker, are increased in subjects with nonalcoholic fatty liver disease. Sci Rep,2019,9(1):1836-1846.
[13] WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.Lancet,2004,363(9403):157-163.
[14] Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci,2000,904:437-448.
[15] Mitchell WK, Williams J, Atherton P, et al. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Front Physiol,2012,3:260.
[16] Hunter GR, Gower BA, Kane BL. Age related shift in visceral fat. Int J Body Compos Res,2010,8(3):103-108.
[17] Gusmao-Sena MH, Curvello-Silva K, Barreto-Medeiros JM, et al. Association between sarcopenic obesity and cardiovascular risk:where are we? Nutr Hosp,2016,33(5):592.
[18] Batsis JA, Barre LK, Mackenzie TA, et al. Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions:dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999-2004. J Am Geriatr Soc,2013,61(6):974-980.
[19] Batsis JA, Villareal DT. Sarcopenic obesity in older adults:aetiology, epidemiology and treatment strategies.Nat Rev Endocrinol,2018,14(9):513-537.
[20] Van Aller C, Lara J, Stephan BCM, et al. Sarcopenic obesity and overall mortality:Results from the application of novel models of body composition phenotypes to the National Health and Nutrition Examination Survey 1999-2004. Clin Nutr,2019,38(1):264-270.
[21] Nachit M, Leclercq IA. Emerging awareness on the importance of skeletal muscle in liver diseases: time to dig deeper into mechanisms! Clin Sci (Lond),2019,133(3):465-481.
[22] Polyzos SA, Margioris AN. Sarcopenic obesity. Hormones (Athens),2018,17(3):321-331.
[23] Kim JA, Choi KM. Sarcopenia and fatty liver disease. Hepatol Int,2019,13(6):674-687.
[24] Lee YH, Jung KS, Kim SU, et al. Sarcopenia is associated with NAFLD independently of obesity and insulin resistance: Nationwide surveys (KNHANES 2008-2011). J Hepatol,2015,63(2):486-493.
[25] Gan D, Wang L, Jia M, et al. Low muscle mass and low muscle strength associate with nonalcoholic fatty liver disease. Clin Nutr,2020,39(4):1124-1130.
[26] Wijarnpreecha K, Panjawatanan P, Thongprayoon C, et al. Sarcopenia and risk of nonalcoholic fatty liver disease: A meta-analysis. Saudi J Gastroenterol,2018,24(1):12-17.
[27] Pacifico L, Perla FM, Andreoli G, et al. Nonalcoholic fatty liver disease is associated with low skeletal muscle mass in overweight/obese youths. Front Pediatr,2020,8:158.
[28] Zhai Y, Xiao Q, Miao J. The relationship between NAFLD and sarcopenia in elderly patients. Can J Gastroenterol Hepatol,2018,2018:5016091.
[29] Kashiwagi K, Takayama M, Fukuhara K, et al. A significant association of non-obese non-alcoholic fatty liver disease with sarcopenic obesity.Clin Nutr ESPEN,2020,38:86-93.
[30] Kang S, Moon MK, Kim W, Koo BK. Association between muscle strength and advanced fibrosis in non-alcoholic fatty liver disease: a Korean nationwide survey. J Cachexia Sarcopenia Muscle,2020,11(5):1232-1241.
[31] Kim KH, Kim BK, Park JY, et al. Sarcopenia assessed using bioimpedance analysis is associated independently with significant liver fibrosis in patients with chronic liver diseases. Eur J Gastroenterol Hepatol,2020,32(1):58-65.
[32] Wijarnpreecha K, Kim D, Raymond P, et al. Associations between sarcopenia and nonalcoholic fatty liver disease and advanced fibrosis in the USA. Eur J Gastroenterol Hepatol,2019,31(9):1121-1128.
[33] Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology,2015,149(2):389-397.
[34] Carias S, Castellanos AL, Vilchez V, et al. Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. J Gastroenterol Hepatol,2016,31(3):628-633.
[35] Haugen CE, McAdams-DeMarco M, Verna EC, et al. Association between liver transplant wait-list mortality and frailty based on body mass index. JAMA Surg,2019,154(12):1103-1109.
[36] Cui Y, Huang C, Momma H, et al. The longitudinal association between alcohol consumption and muscle strength: A population-based prospective study. J Musculoskelet Neuronal Interact,2019,19(3):294-299.
[37] Plauth M, Bernal W, Dasarathy S, et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr,2019,38(2):485-521.
[38] Romero-Gomez M, Zelber-Sagi S, Trenell M. Treatment of NAFLD with diet, physical activity and exercise. J Hepatol,2017,67(4):829-846.
[39] European Association for the Study of the Liver. Electronic addresseee, European association for the study of the L. EASL clinical practice guidelines on nutrition in chronic liver disease. J Hepatol,2019,70(1):172-193.
[40] Himoto T, Miyatake K, Maeba T, Masaki T. Verification of the nutritional and dietary factors associated with skeletal muscle index in Japanese patients with nonalcoholic fatty liver disease. Can J Gastroenterol Hepatol,2020,2020:3576974.
[41] Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, et al. Effects of aerobic and resistance exercise on metabolic syndrome, sarcopenic obesity, and circulating biomarkers in overweight or obese survivors of breast cancer: A randomized controlled trial. J Clin Oncol,2018,36(9):875-883.
[42] Aggio DA, Sartini C, Papacosta O, et al.Cross-sectional associations of objectively measured physical activity and sedentary time with sarcopenia and sarcopenic obesity in older men. Prev Med,2016,91:264-272.
[43] Chen HT, Chung YC, Chen YJ, et al. Effects of different types of exercise on body composition, muscle strength, and IGF-1 in the elderly with sarcopenic obesity. J Am Geriatr Soc,2017,65(4):827-832.
[44] Williams FR, Vallance A, Faulkner T, et al. Home-based exercise in patients awaiting liver transplantation: a feasibility study. Liver Transpl,2019,25(7):995-1006.
[45] Barbat-Artigas S, Garnier S, Joffroy S, et al. Caloric restriction and aerobic exercise in sarcopenic and non-sarcopenic obese women: an observational and retrospective study. J Cachexia Sarcopenia Muscle,2016,7(3):284-289.
[46] Sherif OE, Dhaliwal A, Newsome PN, et al. Sarcopenia in nonalcoholic fatty liver disease: new challenges for clinical practice. Expert Rev Gastroenterol Hepatol,2020,14(3):197-205.
[47] Han HQ, Zhou X, Mitch WE, et al. Myostatin/activin pathway antagonism: molecular basis and therapeutic potential. Int J Biochem Cell Biol,2013,45(10):2333-2347.
[48] Carey EJ, Lai JC, Sonnenday C, et al. A North American expert opinion statement on sarcopenia in liver transplantation. Hepatology,2019,70(5):1816-1829.
[49] Bauer JM, Verlaan S, Bautmans I, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc,2015,16(9):740-747.
[50] Saini A, Sharples AP, Al-Shanti N, et al. Omega-3 fatty acid EPA improves regenerative capacity of mouse skeletal muscle cells exposed to saturated fat and inflammation. Biogerontology,2017,18(1):109-129.