Background: We investigated the association between muscle strength and the prevalence of advanced fibrosis among individuals with nonalcoholic fatty liver disease (NAFLD) using a nationwide cross-sectional survey.

Methods: Individuals, 20 to 79 years of age, from the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2014 to 2016 were selected (n = 14,861), with sample weights applied. Muscle strength was quantified as the hand grip strength (HGS) divided by the body mass index (BMI); low muscle strength (LMS) was defined as the lowest quartile (Q1) of the HGS/BMI scores for our sample population. NAFLD was defined by hepatic steatosis index (HSI) >36 (NAFLDHSI). The highest quartile of NAFLD fibrosis score (NFS) (FibrosisNFS) was used to define advanced fibrosis.

Results: In a crude analysis, LMS was associated with the increased prevalence of NAFLDHSI (OR 3.62, 95% CI 3.25-4.03), which remained significant even after adjustment for age, sex, obesity, and insulin resistance (OR 1.69, 95% CI 1.30-2.18). Even in those without obesity, individuals with LMS had a higher prevalence of NAFLDHSI compared to those without LMS (OR 1.93, 95% CI, 1.42-2.63). Among individuals with NAFLDHSI (n = 3,320), LMS was also associated with the presence of advanced fibrosis (FibrosisNFS) even after adjustment for age, sex, obesity, and insulin resistance (OR 1.68, 95% CI 1.09-2.58).

Conclusion: Muscle strength is independently associated with NAFLD and advanced fibrosis.


S. Kang: None. M. Moon: None. B. Koo: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at