Steatohepatitis with sarcopenia and progression of carotid atherosclerosis in patients with type 2 diabetes: a Korean cohort study

초록

Background The purpose of this study is to evaluate whether hepatic steatosis with or without sarcopenia is associated with progression of carotid atherosclerosis. Methods We investigated 879 type 2 diabetes patients who underwent abdominal ultrasonography, bioelectrical impedance analysis, and repeated carotid artery ultrasonography at baseline and after 6-8 years. Patients with hepatic steatosis confirmed by abdominal ultrasonography were further evaluated for having sarcopenia, defined as a gender-specific skeletal muscle mass index value > 2 standard deviations below the mean for healthy young adults. We investigated the association between steatosis with/without sarcopenia and atherosclerosis progression. Results Of 879 patients, 345 (39.2%) were classified as having hepatic steatosis without sarcopenia and 126 (14.3%) were classified as hepatic steatosis with sarcopenia at baseline. The prevalence of sarcopenia was increased in having hepatic steatosis group (p<0.001). The mean carotid intima-media thickness at baseline gradually increased with having steatosis and sarcopenia. (p for trend = 0.039) After 6-8 years, only individuals with sarcopenia showed significant association with atherosclerosis progression (adjusted odds ratio [AOR]: 1.69, 95% CI: 1.01-2.85; p < 0.05) among patients with hepatic steatosis. The association between sarcopenia and atherosclerosis progression was more significant in non-obese patient group (AOR: 4.38, 95% CI: 1.87-10.26; p= 0.001 in non-obese, AOR: 1.19, 95% CI: 0.59-2.42; p= 0.631 in obese patients). Conclusions Hepatic steatosis with sarcopenia is independently associated with progression of carotid atherosclerosis in patients with type 2 diabetes.