Management of non-alcoholic fatty liver disease in patients with sarcopenia

ABSTRACT

Introduction

Sarcopenia usually occurs with aging, sedentary lifestyle, unhealthy dietary habits, and chronic disorders pathophysiologically and bi-directionally linked to obesity and nonalcoholic fatty liver disease (NAFLD). Because of the global increase in aging and obesity populations, patients with concomitant sarcopenia and NAFLD are common, accompanied by various disorders relevant to obesity and sarcopenia, with across-the-board impact on socio-economic and public health life worldwide. Therefore, developing effective and practical management of these patients has become a pressing clinical issue.

Areas covered

The authors searched literature from PubMed and Ovid MEDLINE up until Feb 2020. Emerging data on the management of sarcopenia and nonalcoholic fatty liver disease were examined and discussed.

Expert opinion

Although NAFLD in patients with sarcopenia has become a critical problem worldwide, we still don’t know much about the management of such patients. Based on theoretical speculations, we can recommend lifestyle intervention, including diet control with adequate protein intake, exercise intervention, and weight reduction as the mainstay of management at the first stage. More studies are needed in the future to identify the most suitable treatment and solve this important problem.

KEYWORDS:

• Sarcopenia
• prognosis
• nonalcoholic fatty liver disease
• aging
• skeletal muscle
• exercise
• sedentary behavior
• weight loss
• feeding behavior
• obesity

Article Highlights Box

• NAFLD is common in patients with sarcopenia because of shared risk factors and pathophysiological mechanisms in both disorders.

• Sarcopenia may predict the survival and adverse outcomes of patients with NAFLD, and vice versa.

• Some pilot studies have shown encouraging results for the therapeutic efficacy of exercise interventions and nutritional supplements on sarcopenic patients.

• Studies examining the use of novel pharmacological agents for NAFLD patients are ongoing and will be available soon, while there remains no study examining the use in subgroup with the co-existence of NAFLD and sarcopenia.

• Future studies with a larger population and longer observation periods to investigate the efficacy of various treatments and identify the predictors on the outcomes of sarcopenic patients with NAFLD are needed.

Declaration of Interest

JH Kao is a consultant for AbbVie, Gilead Sciences, Merck Sharp and Dohme and is on the speaker’s bureau for AbbVie, Bristol-Myers Squibb, Gilead Sciences and Merck Sharp and Dohme. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported in part by grants from the Taipei and Dalin Tzu Chi Hospital, the Buddhist Tzu Chi Medical Foundation, the Ministry of Health and Welfare, the Ministry of Science and Technology, Executive Yuan, Taiwan [TCRD-TPE-107-12 and TCRD-TPE-110-9]