Skeletal muscle loss is associated with diabetes in middle-aged and older Chinese men without non-alcoholic fatty liver disease

BACKGROUND Skeletal muscle,a key insulin target organ,has been reported to be associated with diabetes mellitus(DM).Compared to non-diabetic patients,diabetic patients have decreased muscle mass and a higher prevalence of sarcopenia,and patients with sarcopenia may be at increased risk of developing diabetes.In individuals with nonalcoholic fatty liver disease(NAFLD),sarcopenia is associated with the severity of fibrosis and steatosis.Previous studies have demonstrated that NAFLD is strongly associated with DM and sarcopenia.AIM To determine the relationship between skeletal muscle mass and DM in Chinese middle-aged and elderly men,and whether the association is affected by NAFLD.METHODS Skeletal muscle mass was calculated as appendicular skeletal muscle mass(ASM)in kg/body weight×100%.Liver fat content(LFC)was measured using a quantitative ultrasound method.RESULTS As the ASM decreased,fasting blood glucose(FBG),2-h postprandial blood glucose(2hBG),and LFC increased in both genders,as did the prevalence of DM and NAFLD.Spearman analysis showed that the ASM was negatively correlated with the FBG,2hBG,and LFC.Stepwise logistic regression analysis showed that after adjustments,the ASM quartile was negatively associated with the presence of DM in males,but not in females.Subgroup analysis showed that the ASM quartiles remained negatively correlated with the presence of DM in the non-NAFLD population(including males and females),but no correlation was found between ASM quartiles and the presence of DM in the NAFLD population.When stratified by LFC quartiles,ASM was negatively correlated with the presence of DM in the first and second LFC quartiles in males.CONCLUSION Skeletal muscle mass loss was shown to be associated with the presence of DM in males,but not in females;NAFLD weakens this association.The results suggested that the stratified management of diabetes mellitus should be considered according to skeletal muscle mass and NAFLD.

Ultrasonic integrated backscatter in assessing liver steatosis before and after liver transplantation

BACKGROUND： Liver steatosis affects 20%-30% of adults.Because of the increasing gap between graft supplies and demands, livers with steatosis are frequently used in liver transplantation. But severely steatotic liver grafts are associated with a high risk of intraoperative and postoperative complications. Accurate assessment of fat content of donor livers and monitoring of the extent of steatosis in recipients are required for liver transplantation. The present study aimed to determine the correlation between liver echogenicity and fat content, and to evaluate the use of an ultrasonic integrated backscatter system（IBS） in the assessment of changes in fat content after liver transplantation.METHODS： Seventy-nine consecutive patients receiving liver grafts from living donors were evaluated in our center. Of these recipients, 67 survived for more than two years and were included in this study. Each liver graft was evaluated with IBS and ultrasound before operation and the fat content was estimated. The fat content of the grafts in the recipients was again assessed with ultrasound at 18 months after surgery.RESULTS： A correlation was detected between each graft＇s IBS value and its fat content（P=0.001）. The IBS value in fatty grafts with various degrees of steatosis was significantly decreased in 3（P=0.02）, 12, 15 and 18（P=0.001） months after orthotopic liver transplantation. The IBS value returned to normal in all patients in 18 months after liver transplantation.CONCLUSIONS： Decreased fat content in steatotic grafts can be observed in all recipients. Ultrasonic IBS is useful in determining the steatotic degree of grafts in donors as well as in monitoring the grafts after liver transplantation.

Noninvasive Quantitative Detection Methods of Liver Fat Content in Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease(NAFLD)ranges from simple steatosis to NAFLD-related liver cirrhosis and is a main cause of chronic liver diseases.Patients with nonalcoholic steatohe-patitis and fibrosis are at a great risk of the progression to cirrhosis or hepatocellular carcinoma,both of which are tightly associated with liver-related mortality.Liver biopsy is still the gold standard for the diagnosis of NAFLD,but some defects,such as serious complications,sampling error and variability in histologic evaluation among pathologists,remain problematic.Therefore,noninvasive,repeatable and accurate diagnostic methods are urgently needed.Ultrasonography is a well-established and lower-cost imaging technique for the diagnosis of hepatic steatosis,especially suitable for population census,but limited by its low sensitivity to diagnose mild steatosis and being highly operator-dependent.Computed tomography also lacks the sensitivity to detect mild steatosis and small changes in fat content,and presents a potential radiation hazard.Controlled attenuation parameter based on the FibroScan?technology is a promising tool for noninvasive semiquantita-tive assessment of liver fat content,but the accuracy rate de-pends on the operator's expertise and is affected by age,width of the intercostal space,skin capsular distance and body mass index.Magnetic resonance imaging and magnetic resonance spectroscopy are regarded as the most accurate quantitative methods for measuring liver fat content in clinical practice,especially for longitudinal follow up of NAFLD patients.In this review,we mainly introduce the current imaging methods that are in use for evaluation of liver fat content and we discuss the advantages and disadvantages of each method.