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Review
. 2023 Jan 30;13(1):1645.
doi: 10.1038/s41598-023-28751-5.

Comparative analysis of the relationship between four hepatic steatosis indices and muscle mass

Taesic Lee  1   2 , Tae-Ha Chung  3   4
Affiliations
Review

Comparative analysis of the relationship between four hepatic steatosis indices and muscle mass

Taesic Lee et al. Sci Rep. .

Abstract

Several studies have attempted to validate the relationship between hepatic steatosis and sarcopenia. The crucial limitation is to establish the status of hepatic steatosis by costly or invasive methods. Therefore, several models predicting non-alcoholic fatty liver disease (NAFLD) have been developed but have exhibited heterogeneous results. In this study, we aimed to review and compare four representative models and analyze their relationship with the risk of low muscle mass. Korea National Health and Nutrition Examination Surveys from 2008 to 2011 were used to confirm our hypothesis. Dual-energy X-ray absorptiometry was used to measure the amount of skeletal muscle mass. We used four hepatic steatosis indices: hepatic steatosis index (HSI), Framingham steatosis index (FSI), liver fat score (LFS), and fatty liver index (FLI). Multivariate linear and logistic regressions were used to reveal the relationship between NAFLD and low skeletal muscle index (LSMI). Pairs of FSI-FLI and HSI-FLI exhibited the best and second-best correlations among all possible pairs. The four hepatic steatosis models were associated with increased risk for LSMI. After removing the body mass index effect, HSI and FLI remained robust predictors for LSMI. NAFLD was a significant and potent risk factor for low skeletal muscle.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Comparison among scoring indices for fatty liver. Numeric values indicate the number of subjects with indices for fatty liver in men (A) and women (B).HSI hepatic steatosis index, FSI Framingham steatosis index, LFS NAFLD liver fat score, FLI fatty liver index.
Figure 2
Figure 2
Correlation matrix among four indices for fatty liver in Korean men (A) and women (B). Distributions located in the diagonal are for each index for fatty liver. A scatter plot in the xth row and yth column indicates the correlation between xth index and yth index, and its slope is described by a red dotted line in the scatter plot and a value placed on the xth column and yth row. Comparison between LFS and FLI could not be performed because no sample had both data. Figures in the upper triangle matrix indicate PCC. HSI hepatic steatosis index, FSI Framingham steatosis index, LFS NAFLD liver fat score, FLI fatty liver index, PCC Pearson’s correlation coefficient.
Figure 2
Figure 2
Correlation matrix among four indices for fatty liver in Korean men (A) and women (B). Distributions located in the diagonal are for each index for fatty liver. A scatter plot in the xth row and yth column indicates the correlation between xth index and yth index, and its slope is described by a red dotted line in the scatter plot and a value placed on the xth column and yth row. Comparison between LFS and FLI could not be performed because no sample had both data. Figures in the upper triangle matrix indicate PCC. HSI hepatic steatosis index, FSI Framingham steatosis index, LFS NAFLD liver fat score, FLI fatty liver index, PCC Pearson’s correlation coefficient.
Figure 3
Figure 3
Relationships between SMI (ASM/BMI) and four hepatic steatosis indices. SMI and four indices are used as dependent and independent variables, respectively. Y-axes indicate beta-coefficients calculated by multivariate linear regression models including age, physical activity, current smoking, daily protein intake, hypertension, type 2 diabetes, dyslipidemia, CVD, systolic blood pressure, serum fasting glucose, total cholesterol, and serum creatinine as covariates. Brown bars indicate that the analysis was conducted using an index for fatty liver with a zero value of BMI coefficient. SMI skeletal muscle index, ASM appendicular skeletal muscle, BMI body mass index, HSI hepatic steatosis index, FSI Framingham steatosis index, LFS NAFLD liver fat score, FLI fatty liver index. *, **, *** indicate p-value < 0.05, < 0.01, < 0.001, respectively.
Figure 4
Figure 4
Relationships between LSMI and four hepatic steatosis indices. LSMI status (presence vs. absence) and four indices in Korean men (A) and women (B) were used as dependent and independent variables, respectively. X-axes indicate odds ratio and 95% confidence interval calculated by multivariate logistic regression models, which include age, physical activity, current smoking, daily protein intake, hypertension, type 2 diabetes, dyslipidemia, CVD, systolic blood pressure, serum fasting glucose, total cholesterol, and serum creatinine as covariates. Brown points and lines indicate that the analysis was conducted using indices for fatty liver with a zero value of BMI coefficient. LSMI low skeletal muscle index, BMI body mass index, HSI hepatic steatosis index, FSI Framingham steatosis index, LFS NAFLD liver fat score, FLI fatty liver index.
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