{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:32:31Z","timestamp":1790616751174,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2022R1I1A1A01066469"],"award-info":[{"award-number":["NRF-2022R1I1A1A01066469"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"award":["NRF-2022R1I1A1A01066469"],"award-info":[{"award-number":["NRF-2022R1I1A1A01066469"]}],"id":[{"id":"https:\/\/ror.org\/013aysd81","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: This study examined the independent and combined associations of hand-grip strength (HGS) and arm muscle mass index with risk of non-alcoholic fatty liver disease (NAFLD) in individuals who use wheelchairs. Methods: Eighty-five individuals aged \u2265 30 years who use wheelchairs were enrolled as volunteers from sports welfare facilities for individuals with disabilities in \u201cG\u201d and \u201cC\u201d provinces. HGS was measured using a dynamometer, whereas the arm muscle mass index was assessed using a body composition analyzer. Risk of NAFLD was defined as a hepatic steatosis index (HSI) &gt; 36 and Framingham steatosis index (FSI) \u2265 23. Results: The low-HGS group (HSI, odds ratio [OR] = 3.589, p = 0.013; FSI, OR = 2.710, p = 0.031) had a significantly higher NAFLD risk compared to the high-HGS group (reference, OR = 1). The low-arm-muscle-mass-index group showed a higher risk of NAFLD (HSI, OR = 2.762, p = 0.043; FSI, OR = 3.493, p = 0.007) compared to the high-arm-muscle-mass-index group (reference, OR = 1). Combining the low-HGS + low-arm-muscle-mass-index group (HSI, OR = 6.849, p = 0.006; FSI, OR = 6.957, p = 0.002) showed a significantly higher risk of NAFLD compared to the high-HGS + high-arm-muscle-mass-index group (reference, OR = 1), even after adjusting for covariates (HSI, OR = 7.352, p = 0.006; FSI, OR = 7.406, p = 0.003). Conclusions: Low HGS and low arm muscle mass index are independently associated with a higher risk of NAFLD in individuals who use wheelchairs, with low HGS plus low arm muscle mass index further increasing this risk.<\/jats:p>","DOI":"10.3390\/nu18111715","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:36:56Z","timestamp":1779892616000},"page":"1715","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Associations of Hand-Grip Strength and Arm Muscle Mass Index Relative to Body Weight with Risk of Non-Alcoholic Fatty Liver Disease in Wheelchair Users"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7041-6480","authenticated-orcid":false,"given":"Minjun","family":"Kim","sequence":"first","affiliation":[{"name":"Research Institute of Sports Science, Changwon National University, Changwon 51140, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeonghyeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Changwon National University, Changwon 51140, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7366-0697","authenticated-orcid":false,"given":"Inhwan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Education, Changwon National University, Changwon 51140, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1038\/nrgastro.2013.171","article-title":"The global NAFLD epidemic","volume":"10","author":"Loomba","year":"2013","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease: Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11124","DOI":"10.1038\/s41598-019-47687-3","article-title":"Nonalcoholic fatty liver disease and mortality from all causes, cardiovascular disease, and cancer: A meta-analysis","volume":"9","author":"Liu","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.21037\/tgh.2019.09.08","article-title":"Epidemiology of non-alcoholic and alcoholic fatty liver diseases","volume":"5","author":"Mitra","year":"2020","journal-title":"Transl. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.apmr.2007.02.031","article-title":"A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia","volume":"88","author":"Nash","year":"2007","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.pmr.2007.03.004","article-title":"Obesity after spinal cord injury","volume":"18","author":"Gater","year":"2007","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1038\/sj.sc.3102171","article-title":"Serum leptin, abdominal obesity and the metabolic syndrome in individuals with chronic spinal cord injury","volume":"46","author":"Maruyama","year":"2008","journal-title":"Spinal Cord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/1756283X11430859","article-title":"Secondary causes of nonalcoholic fatty liver disease","volume":"5","author":"Kneeman","year":"2012","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/osp4.643","article-title":"Interaction between increasing body mass index and spinal cord injury to the probability of developing a diagnosis of nonalcoholic fatty liver disease","volume":"9","author":"Eisenberg","year":"2022","journal-title":"Obes. Sci. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1179\/2045772314Y.0000000288","article-title":"Low testosterone and non-alcoholic fatty liver disease: Evidence for their independent association in men with chronic spinal cord injury","volume":"39","author":"Barbonetti","year":"2016","journal-title":"J. Spinal Cord. Med."},{"key":"ref_12","first-page":"79","article-title":"Independent association of hypovitaminosis D with non-alcoholic fatty liver disease in people with chronic spinal cord injury: A cross-sectional study","volume":"47","author":"Castellini","year":"2024","journal-title":"J. Endocrinol. Investig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1002\/hep.29420","article-title":"Sarcopenia in hiding: The risk and consequence of underestimating muscle dysfunction in nonalcoholic steatohepatitis","volume":"66","author":"Bhanji","year":"2017","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12072-019-09964-1","article-title":"Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: A systematic review and meta-analysis","volume":"14","author":"Cai","year":"2020","journal-title":"Hepatol. Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.jhep.2022.01.010","article-title":"Associations of muscle mass and grip strength with severe NAFLD: A prospective study of 333,295 UK Biobank participants","volume":"76","author":"Gray","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.clnu.2019.04.023","article-title":"Low muscle mass and low muscle strength associate with nonalcoholic fatty liver disease","volume":"39","author":"Gan","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1002\/mus.21391","article-title":"Muscle after spinal cord injury","volume":"40","author":"Kristensen","year":"2009","journal-title":"Muscle Nerve"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"655","DOI":"10.3233\/THC-161162","article-title":"A low arm and leg muscle mass to total body weight ratio is associated with an increased prevalence of metabolic syndrome: The Korea National Health and Nutrition Examination Survey 2010\u20132011","volume":"24","author":"Kim","year":"2016","journal-title":"Technol. Health Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.dld.2009.08.002","article-title":"Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease","volume":"42","author":"Lee","year":"2010","journal-title":"Dig. Liver Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Jung, T.Y., Kim, M.S., Hong, H.P., Kang, K.A., and Jun, D.W. (2020). Comparative assessment and external validation of hepatic steatosis formulae in a community-based setting. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092851"},{"key":"ref_21","unstructured":"Korea Disabled People Development Institute (2022). Panel Survey on Living with Disabilities 2018\u20132022, Korea Disabled People Development Institute."},{"key":"ref_22","unstructured":"Centers for Disease Control and Prevention (CDC) (1994). Cigarette smoking among adults\u2014United States, 1992, and changes in the definition of current cigarette smoking. MMWR Morb. Mortal. Wkly. Rep., 43, 342\u2013346."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1123\/jpah.4.1.96","article-title":"The Physical Activity Scale for Individuals with Physical Disabilities: Test-retest reliability and comparison with an accelerometer","volume":"4","author":"Streppel","year":"2007","journal-title":"J. Phys. Act. Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3350\/cmh.2019.0065","article-title":"Trends in the prevalence of chronic liver disease in the Korean adult population, 1998\u20132017","volume":"26","author":"Park","year":"2020","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2264","DOI":"10.2337\/dc07-0372","article-title":"Muscle-strengthening activity and its association with insulin sensitivity","volume":"30","author":"Cheng","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1111\/obr.12166","article-title":"Potential role of skeletal muscle glucose metabolism on the regulation of insulin secretion","volume":"15","author":"Mizgier","year":"2014","journal-title":"Obes. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/s11684-013-0262-6","article-title":"Mechanisms of insulin resistance in obesity","volume":"7","author":"Ye","year":"2013","journal-title":"Front. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1002\/oby.23227","article-title":"Skeletal muscle energy metabolism in obesity","volume":"29","author":"Mengeste","year":"2021","journal-title":"Obesity"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1089\/met.2018.0077","article-title":"Relationship between handgrip strength and nonalcoholic fatty liver disease: Nationwide surveys","volume":"16","author":"Lee","year":"2018","journal-title":"Metab. Syndr. Relat. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4547","DOI":"10.18632\/aging.102068","article-title":"Lower hand grip strength in older adults with non-alcoholic fatty liver disease: A nationwide population-based study","volume":"11","author":"Kim","year":"2019","journal-title":"Aging"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Lee, S.B., Kwon, Y.J., Jung, D.H., and Kim, J.K. (2022). Association of muscle strength with non-alcoholic fatty liver disease in Korean adults. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031675"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Xia, Y., Cao, L., Liu, Y., Wang, X., Zhang, S., Meng, G., Zhang, Q., Liu, L., Wu, H., and Gu, Y. (2021). Longitudinal associations between hand grip strength and non-alcoholic fatty liver disease in adults: A prospective cohort study. Front. Med., 8.","DOI":"10.3389\/fmed.2021.752999"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1002\/hep.30049","article-title":"Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: A 7-year longitudinal study","volume":"68","author":"Kim","year":"2018","journal-title":"Hepatology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"100197","DOI":"10.1016\/j.jhepr.2020.100197","article-title":"Adverse muscle composition is linked to poor functional performance and metabolic comorbidities in NAFLD","volume":"3","author":"Linge","year":"2020","journal-title":"JHEP Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"B209","DOI":"10.1093\/gerona\/56.5.B209","article-title":"Longitudinal muscle strength changes in older adults: Influence of muscle mass, physical activity, and health","volume":"56","author":"Hughes","year":"2001","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1249\/MSS.0000000000001390","article-title":"Impact of exercise on cardiometabolic component risks in spinal cord-injured humans","volume":"49","author":"Nightingale","year":"2017","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3377","DOI":"10.3748\/wjg.v17.i29.3377","article-title":"Nutrition and physical activity in NAFLD: An overview of the epidemiological evidence","volume":"17","author":"Ratziu","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1111\/apt.12038","article-title":"Non-alcoholic fatty liver disease is associated with low level of physical activity: A population-based study","volume":"36","author":"Gerber","year":"2012","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"60","DOI":"10.46292\/sci20-00040","article-title":"Handgrip strength cutoff points for functional independence and wheelchair ability in men with spinal cord injury","volume":"27","author":"Neto","year":"2021","journal-title":"Top. Spinal Cord. Inj. Rehabil."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ahn, H., Choi, H.Y., and Ki, M. (2022). Association between levels of physical activity and low handgrip strength: Korea National Health and Nutrition Examination Survey 2014\u20132019. Epidemiol. Health, 44.","DOI":"10.4178\/epih.e2022027"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1519\/JSC.0b013e3181bdddda","article-title":"Effects of heavy resistance training on strength and power in upper extremities in wheelchair athletes","volume":"24","author":"Turbanski","year":"2010","journal-title":"J. Strength Cond. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1002\/hep.28010","article-title":"Sarcopenia and nonalcoholic fatty liver disease: New evidence for low vitamin D status contributing to the link","volume":"63","author":"Pang","year":"2016","journal-title":"Hepatology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3803\/EnM.2020.35.1.1","article-title":"Impact of skeletal muscle mass on metabolic health","volume":"35","author":"Kim","year":"2020","journal-title":"Endocrinol. Metab."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/11\/1715\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T04:28:43Z","timestamp":1780633723000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/11\/1715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18111715"],"URL":"https:\/\/doi.org\/10.3390\/nu18111715","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}