Sarcopenia modifies the associations of nonalcoholic fatty liver disease with all-cause and cardiovascular mortality among older adults

The contribution of nonalcoholic fatty liver disease (NAFLD) to all-cause and cardiovascular mortality remains controversial. Sarcopenia, a measure of muscle mass, strength and function, may identify which persons are most at risk for adverse effects of NAFLD. We aimed to test the hypothesis that sarcopenia modifies the associations between NAFLD and all-cause and cardiovascular mortality. A total of 2446 older adults (≥ 60 years) from the third National Health and Nutrition Examination Survey were enrolled. Their mortality data were linked to death certificates in the National Death Index. Sarcopenia was defined as having low skeletal muscle mass together with slow gait speed, which captures both muscle mass and muscle function. Ultrasound tests were used for the assessment of hepatic steatosis. During follow-up (median 16.8 years), 1530 older subjects died from any cause, of which 379 were cardiovascular-related. All-cause and cardiovascular mortality rates were 4.31 and 1.07 per 100 person-years, respectively. In a multivariate model, using participants without NAFLD and sarcopenia as the reference group, individuals with both NAFLD and sarcopenia had 1.69 times [95% confidence interval (CI) 1.23–2.31] and 2.17 times (95% CI 1.33–3.54) higher risks of all-cause and cardiovascular mortality, respectively. However, NAFLD persons without sarcopenia had hazard ratios for all-cause and cardiovascular mortality similar to those of the reference group. Sarcopenia modified the associations of NAFLD with all-cause and cardiovascular mortality. Sarcopenia may identify older adults who are at the highest risk for adverse outcomes associated with NAFLD.