Background and Aims: Recent epidemiological studies have suggested the association between sarcopenia and nonalcoholic fatty liver disease (NAFLD) in the general population. However, the association between skeletal muscle mass and hepatic steatosis in patients with type 2 diabetes mellitus (T2DM) has not been well studied. Therefore, we investigated the association between skeletal muscle index (SMI) and hepatic steatosis in patients with T2DM.

Methods: In this cross-sectional study, a total of 5,394 patients (2,718 men and 2,676 women) with T2DM were recruited from the outpatient clinic of Huh’s Diabetes Center from 2003 to 2016. Those patients who had a history of viral or other liver diseases or had alcohol consumption ≥140 g/week were excluded from the study. Skeletal muscle mass was estimated from bioimpedance analysis measurements and skeletal muscle mass index (SMI, %) was defined as skeletal muscle mass (kg)/total body weight (kg) × 100. NAFLD was defined as the presence of hepatic steatosis on ultrasonography.

Results: Thirty-six percent of men and 38% of women had NAFLD. Those with NAFLD had higher body mass index (BMI), waist circumference (WC), HbA1c, total cholesterol, triglyceride and blood pressure and lower HDL-cholesterol. SMI was lower in those with NAFLD (44.7 ± 8.1 vs. 45.7 ± 8.6%, p<0.001 in men and 37.6 ± 8.3 vs. 38.7 ± 8.9%, p=0.002 in women). Lower SMI tertiles were independently associated with higher prevalence of NAFLD (Ptrend<0.001). Odds ratio for NAFLD was 1.72 (95% confidence interval [CI] 1.25-2.37; p = 0.001) in patients with lowest SMI tertile compared with highest tertile after adjusting for possible confounding factors.

Conclusion: Low skeletal muscle mass is independently associated with NAFLD in patients with T2DM. These findings suggest that sarcopenia is a risk factor for NAFLD in patients with T2DM.


D. Seo: None. M. Jung: None. S. Ahn: None. S. Hong: None. M. Nam: None. Y. Lee: None. Y. Choi: None. B. Huh: None. K. Huh: None. S. Kim: None.


National Research Foundation of Korea (2017R1D-1A1B03034581)

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