Journal of Gastroenterology

, Volume 53, Issue 4, pp 535–547 | Cite as

Skeletal muscle mass to visceral fat area ratio is an important determinant affecting hepatic conditions of non-alcoholic fatty liver disease

  • Takashi Shida
  • Kentaro Akiyama
  • Sechang Oh
  • Akemi Sawai
  • Tomonori Isobe
  • Yoshikazu Okamoto
  • Kazunori Ishige
  • Yuji Mizokami
  • Kenji Yamagata
  • Kojiro Onizawa
  • Hironori Tanaka
  • Hiroko Iijima
  • Junichi Shoda
Original Article—Liver, Pancreas, and Biliary Tract



Not only obesity but also sarcopenia is associated with NAFLD. The influence of altered body composition on the pathophysiology of NAFLD has not been fully elucidated. The aim of this study is to determine whether skeletal muscle mass to visceral fat area ratio (SV ratio) affects NAFLD pathophysiology.


A total of 472 subjects were enrolled. The association between SV ratio and NAFLD pathophysiological factors was assessed in a cross-sectional nature by stratification analysis.


When the SV ratio was stratified by quartiles (Q 1Q 4), the SV ratio showed a negative relationship with the degree of body mass index, HOMA-IR, and liver stiffness (Q 1, 8.9 ± 7.5 kPa, mean ± standard deviation; Q 2, 7.5 ± 6.2; Q 3, 5.8 ± 3.7; Q 4, 5.0 ± 1.9) and steatosis (Q 1, 282 ± 57 dB/m; Q 2, 278 ± 58; Q 3, 253 ± 57; Q 4, 200 ± 42) measured by transient elastography. Levels of leptin and biochemical markers of liver cell damage, liver fibrosis, inflammation and oxidative stress, and hepatocyte apoptosis were significantly higher in subjects in Q 1 than in those in Q 2, Q 3, or Q 4. Moreover, fat contents in femoral muscles were significantly higher in subjects in Q 1 and the change was associated with weakened muscle strength. In logistic regression analysis, NAFLD subjects with the decreased SV ratio were likely to have an increased risk of moderate-to-severe steatosis and that of advanced fibrosis.


Decreased muscle mass coupled with increased visceral fat mass is closely associated with an increased risk for exacerbating NAFLD pathophysiology.


Non-alcoholic fatty liver disease Skeletal muscle mass to visceral fat area ratio Liver steatosis Liver fibrosis Pathophysiology 



Alanine aminotransferase


Aspartate aminotransferase


Body mass index


Controlled attenuation parameter


Contrast-enhanced ultrasonography


Extra-myocellular lipid


Free fatty acid


Fibroblast growth factor 21


Fasting plasma glucose


High-density lipoprotein-cholesterol


Homeostasis model assessment-insulin resistance


High-sensitivity C-reactive protein


Intrahepatic lipid




Intra-myocellular lipid


Low-density lipoprotein-cholesterol




Liver stiffness


Proton magnetic resonance spectroscopy




Non-alcoholic fatty liver disease


Non-alcoholic steatohepatitis



SV ratio

Skeletal muscle mass to visceral fat area ratio


2-Thiobarbituric acid reactive substances




Tumor necrosis factor-α




Visceral fat area


Very low density lipoprotein


Wisteria floribunda agglutinin-positive Mac-2 binding protein


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.


This work was supported by in part by Grants-in-Aids for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology, Japan (Nos. 25282212, 26282191, 26293284, 26293297, 26670109, 15K15037, 15K15488, and 16K15188).


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Copyright information

© Japanese Society of Gastroenterology 2017

Authors and Affiliations

  • Takashi Shida
    • 1
  • Kentaro Akiyama
    • 1
    • 2
  • Sechang Oh
    • 3
  • Akemi Sawai
    • 1
  • Tomonori Isobe
    • 4
  • Yoshikazu Okamoto
    • 5
  • Kazunori Ishige
    • 6
  • Yuji Mizokami
    • 6
  • Kenji Yamagata
    • 7
  • Kojiro Onizawa
    • 7
  • Hironori Tanaka
    • 8
    • 9
  • Hiroko Iijima
    • 8
  • Junichi Shoda
    • 4
  1. 1.Doctoral Programs in Medical Sciences, Graduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaJapan
  2. 2.Japan Society for the Promotion of ScienceTokyoJapan
  3. 3.The Center of Sports Medicine and Health SciencesTsukuba University HospitalIbarakiJapan
  4. 4.Medical Sciences, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  5. 5.Division of Radiology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  6. 6.Division of Gastroenterology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  7. 7.Division of Oral and Maxillofacial Surgery, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  8. 8.Division of Internal MedicineHyogo College of MedicineNishinomiyaJapan
  9. 9.Division of GastroenterologyTakarazuka City HospitalTakarazukaJapan

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