Association of Low Skeletal Muscle Mass with the Phenotype of Lean Non-Alcoholic Fatty Liver Disease

Low skeletal muscle mass (LSMM) has emerged as a potential risk factor for non-alcoholic fatty liver disease (NAFLD). However, its clinical implications in patients with lean NAFLD have not yet been elucidated. We investigated the role of LSMM in patients with lean NAFLD. Lean NAFLD was defined as a body mass index of ≤23 kg/m(2). Using bioelectrical impedance analysis, the appendicular skeletal muscle mass (ASM) was adjusted by height squared. The LSMM was based on 1 SD below the sex-specific mean for young, healthy Asian adults. Of the 8905 ultrasound-confirmed NAFLD patients, 3670 (41.2%) were diagnosed with lean NAFLD. The lean NAFLD group was younger (45.0 vs. 49.0 years, p < 0.001), and had a lower waist circumference (74.0 vs. 85.0 cm, p < 0.001), lower prevalence of diabetes (3.1 vs. 7.4%, p < 0.001) and hypertension (4.2 vs. 15.2%, p < 0.001), and a higher proportion of LSMM (28.0 vs. 2.2%, p < 0.001) than the non-lean NAFLD group. Stepwise adjusted models suggested that LSMM was associated with lean individuals with NAFLD (odds ratio = 7.02, p < 0.001). LSMM may be a novel risk factor for lean NAFLD patients more than non-lean NAFLD patients, independent of classic metabolic factors.