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Body composition, energy expenditure and physical activity

Association of grip strength with non-alcoholic fatty liver disease: investigation of the roles of insulin resistance and inflammation as mediators

European Journal of Clinical Nutrition volume 74, pages 1401–1409 (2020)Cite this article

Subjects

Abstract

Background/objectives

The purpose of this study was to examine the association between muscle weakness and non-alcoholic fatty liver disease (NAFLD), and whether the association is partly explained by insulin resistance or inflammation.

Subjects/methods

Subjects were 3922 adults who participated in the 2015 Korea National Health and Nutrition Examination Survey. Relative grip strength (rGS; calculated as maximal grip strength divided by BMI) was used to predict NAFLD defined by NAFLD liver fat score. Participants were classified into four groups according to the quartiles of rGS distribution (Q1–Q4). Insulin resistance was assessed by triglycerides and glucose (TyG) index. Inflammation was measured with C-reactive protein (CRP). Fibrosis was assessed by the Fibrosis-4 index (FIB-4) and the NAFLD fibrosis score.

Results

rGS had significant negative associations with TyG index and CRP (all p < 0.001). rGS was a significant predictor of NAFLD (OR, 0.54–0.19 in Q2–Q4 men; OR, 0.54–0.08 in Q2–Q4 women, all p < 0.001). Adjustment for other participant factors did not substantially affect the results. Addition of TyG index changed the estimates for NAFLD slightly and addition of CRP increased the ORs by 10–20% in Q3–Q4 women. In the subpopulation with NAFLD (n = 946), rGS showed strong inverse relationships with FIB-4 and NAFLD fibrosis score (all p < 0.001).

Conclusions

Grip strength was inversely associated not only with the risk of NAFLD but also with its severity. Insulin resistance and inflammation explained only a small portion of the association between grip strength and NAFLD risk.

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Fig. 1: Distribution of NAFLD liver fat score quartiles according to relative grip strength quartiles.
Fig. 2: Liver fibrosis scores according to relative grip strength quartiles (n = 946).
Fig. 3: Distribution of liver fibrosis score quartiles according to relative grip strength quartiles (n = 946).

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Acknowledgements

This work was supported by a grant from Research year of Inje University in 2019 (20170100).

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Authors and Affiliations

  1. Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, Republic of Korea

    Seung Ha Park

  2. Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Gangwon, Republic of Korea

    Dong Joon Kim

  3. Institute for Liver and Digestive Diseases, Hallym University, Chuncheon, Gangwon, Republic of Korea

    Dong Joon Kim

  4. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Lindsay D. Plank

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SHP was responsible for study concept, data collection, statistical analysis, interpretation of results, and writing of article; DJK were responsible for data collection, statistical analysis, and interpretation of results; LDP was responsible for conceiving and designing the work, statistical analysis, interpretation of results, and writing and supervising the manuscript.

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Correspondence to Lindsay D. Plank.

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Park, S.H., Kim, D.J. & Plank, L.D. Association of grip strength with non-alcoholic fatty liver disease: investigation of the roles of insulin resistance and inflammation as mediators. Eur J Clin Nutr 74, 1401–1409 (2020). https://doi.org/10.1038/s41430-020-0591-x

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