Cardiovascular and Liver Diseases in Subjects With Sarcopenic Obesity and Nonalcoholic Fatty Liver Disease

I read with great interest the article by Chun et al.1Chun H.S. et al.Clin Gastroenterol Hepatol. 2023; 21: 2298-2307.e18Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar In this study, the authors examined the association between the severity of sarcopenic obesity (SO) in patients with nonalcoholic fatty liver disease (NAFLD) and the risk of liver fibrosis or cardiovascular disease (CVD). By logistic regression analysis, the adjusted odds ratios of SO for liver fibrosis and CVD increased significantly. In addition, the cumulative incidence of liver fibrosis or CVD increased significantly in subjects with SO, with a subdistribution hazard ratio of 5.37 considering all-cause mortality and liver transplantation as competing risks. I present recent information relevant to the study. Sarcopenia is a risk factor for metabolic syndrome, presenting a dose-response relationship.2Kim S.H. et al.PLoS One. 2021; 16e0248856Google Scholar In addition, it can be easily suspected that SO is closely related to the risk of CVD.3Evans K. et al.Postgrad Med. 2021; 133: 831-842Crossref PubMed Scopus (22) Google Scholar Although NAFLD is not a component of metabolic syndrome, recent studies suggest that NAFLD can be considered as an additional component of metabolic syndrome and subsequent risk of CVD. Kouvari et al4Kouvari M. et al.Clin Nutr. 2022; 41: 1281-1289Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar examined the effect of low skeletal muscle mass (SMI) in subjects with NAFLD on 10-year incidence of CVD with special reference to central obesity. There was a significant association between NAFLD and 10-year CVD incidence in participants with low SMI, but there was no significant association in those with moderate/high SMI. Furthermore, participants with increased SMI and lower abdominal obesity had a strong contribution to lower rates of NAFLD. This means that SO is closely related to the risk of CVD and NAFLD, and an interrelationship among SO, NAFLD, and CVD may exist. Regarding the risk assessment of hepatic disease, Shida et al5Shida T. et al.J Gastroenterol. 2018; 53: 535-547Crossref PubMed Scopus (55) Google Scholar examined the association between SMI to visceral fat area ratio and NAFLD, assuming that SMI to visceral fat area ratio is an effective indicator of SO. NAFLD subjects with decreased SMI to visceral fat area ratio had an increased risk of moderate-to-severe steatosis and advanced fibrosis. There is need for a simple method for detecting early stage of transition from NAFLD to hepatic fibrosis, by combining SO with biologic markers. Actions for preventing CVD and liver disease are urgently needed, and adequate evaluation of SO may become an effective screening tool. Nonalcoholic Steatohepatitis Decompensation and Portal PressuresClinical Gastroenterology and HepatologyVol. 21Issue 10PreviewWe read with great interest the recent article published by Bassegoda et al.1 As suggested in their study, portal pressure measurements commonly performed in subjects with nonalcoholic fatty liver disease could be underestimated. This underestimation seems to be present in patients with and without cirrhosis.2,3 Their article highlights this discrepancy in advanced fibrosis stages and in some patients with decompensation. This could have significant clinical implications because hepatic venous pressure gradient (HVPG) measurements are used for diagnostic and therapeutic considerations. Full-Text PDF