{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:33:27Z","timestamp":1790616807810,"version":"4.1.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T00:00:00Z","timestamp":1651536000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The effect of sarcopenic visceral obesity on the risk of nonalcoholic fatty liver disease (NAFLD) is uncertain. We investigated (a) whether the skeletal muscle mass to visceral fat area ratio (SV ratio), as a measure of sarcopenic visceral obesity, is a risk factor for NAFLD; and (b) whether the SV ratio adds to conventional adiposity measures to improve prediction of incident NAFLD. Adults without NAFLD (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u00a0=\u00a0151,017) were followed up for a median of 3.7\u2009years. Hepatic steatosis was measured using ultrasonography, and liver fibrosis scores were estimated using the Fibrosis\u20104 index (FIB\u20104) and the NAFLD Fibrosis Score (NFS). Cox proportional hazards models were used to determine sex\u2010specific adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]). The incremental predictive performance was assessed using the area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Multivariable aHRs (95% CIs) for incident NAFLD comparing the lowest versus the highest quintile of SV ratio were 3.77 (3.56\u20133.99) for men and 11.69 (10.46\u201313.06) for women (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2013interaction by sex\u2009&lt;\u20090.001). For incident NAFLD with intermediate\/high FIB\u20104, aHRs were 2.83 (2.19\u20133.64) for men and 7.96 (3.85\u201316.44) for women (similar results were obtained for NFS). Associations remained significant even after adjustment for body mass index, waist circumference, and time\u2010varying covariates. These associations were also more pronounced in nonobese than obese participants (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2013interaction\u2009&lt;\u20090.001). The addition of SV ratio to conventional adiposity measures modestly improved risk prediction for incident NAFLD. SV ratio was inversely associated with risk of developing NAFLD, with effect modification by sex and obesity.\n                    <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>\n                    : Low SV ratio is a complementary index to conventional adiposity measures in the evaluation of NAFLD risk.\n                  <\/jats:p>","DOI":"10.1002\/hep4.1975","type":"journal-article","created":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T13:49:51Z","timestamp":1651585791000},"page":"2238-2252","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":32,"title":["Skeletal muscle mass to visceral fat area ratio as a predictor of NAFLD in lean and overweight men and women with effect modification by sex"],"prefix":"10.1097","volume":"6","author":[{"given":"Yoosun","family":"Cho","sequence":"first","affiliation":[{"name":"Total Healthcare Center,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6945-9050","authenticated-orcid":false,"given":"Yoosoo","family":"Chang","sequence":"additional","affiliation":[{"name":"Center for Cohort Studies,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"},{"name":"Department of Occupational and Environmental Medicine,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"},{"name":"Department of Clinical Research Design & Evaluation,Samsung Advanced Institute for Health Sciences & Technology,Sungkyunkwan University,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3927-8646","authenticated-orcid":false,"given":"Seungho","family":"Ryu","sequence":"additional","affiliation":[{"name":"Center for Cohort Studies,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"},{"name":"Department of Occupational and Environmental Medicine,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"},{"name":"Department of Clinical Research Design & Evaluation,Samsung Advanced Institute for Health Sciences & Technology,Sungkyunkwan University,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun\u2010Suk","family":"Jung","sequence":"additional","affiliation":[{"name":"Total Healthcare Center,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan\u2010won","family":"Kim","sequence":"additional","affiliation":[{"name":"Total Healthcare Center,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyungseok","family":"Oh","sequence":"additional","affiliation":[{"name":"Total Healthcare Center,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine,College of Medicine,Hanyang University,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won","family":"Sohn","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Department of Internal Medicine,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hocheol","family":"Shin","sequence":"additional","affiliation":[{"name":"Center for Cohort Studies,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"},{"name":"Department of Family Medicine,Kangbuk Samsung Hospital,Sungkyunkwan University School of Medicine,Seoul,Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah H.","family":"Wild","sequence":"additional","affiliation":[{"name":"Usher Institute,University of Edinburgh,Edinburgh,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6322-7753","authenticated-orcid":false,"given":"Christopher D.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Nutrition and Metabolism,Faculty of Medicine,University of Southampton,Southampton,UK"},{"name":"National Institute for Health Research Southampton Biomedical Research Center,University Hospital Southampton,Southampton,UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,5,3]]},"reference":[{"key":"hep41975-bib-0001-20241118","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease\u2014meta\u2010analytic assessment of prevalence, incidence, and outcomes","volume":"64","year":"2016","journal-title":"Hepatology"},{"key":"hep41975-bib-0002-20241118","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"NAFLD: a multisystem disease","volume":"62","year":"2015","journal-title":"J Hepatol"},{"key":"hep41975-bib-0003-20241118","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.jhep.2020.01.013","article-title":"NAFLD as a driver of chronic kidney disease","volume":"72","year":"2020","journal-title":"J 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