Low vitamin D levels accelerates muscle mass loss in patients with chronic liver disease

1. In a cohort of patients with chronic liver disease, low vitamin D levels were significantly and independently associated with skeletal muscle mass loss within one year.

2. Nonalcoholic fatty liver disease (NAFLD) bore the strongest associations to low 25-hydroxyvitamin D levels and muscle loss. 

Evidence Rating Level: 2 (Good)

Sarcopenia, the loss of skeletal muscle mass and strength, is a common sequelae of disease in patients with cirrhosis. The presence of sarcopenia (or even the general loss of muscle mass) also tends to worsen the prognosis of these patients. The loss of lean mass in individuals without cirrhosis is 1% per year (ages 30 to 70) and 1.5% annually thereafter, versus a 2.2% annual rate of skeletal muscle mass loss in individuals with cirrhosis which worsens with more severe Child-Pugh class scores. Branched-chain amino acid (BCAA) and/or vitamin D supplementation and exercise are preventative lifestyle measures, and many longitudinal studies of older adults have revealed the association between low vitamin D levels and muscle mass loss, with deficiency being associated with atrophy of fast-twitch muscle fibres and fatty infiltration of skeletal muscle. The current retrospective study analyzed data from 166 individuals (59.0% female, median [IQR] age 68 [58-74] years) to investigate several factors associated with muscle loss at one-year follow-up for patients with chronic liver disease. Etiologies included chronic hepatitis C viral infection (HCV), nonalcoholic fatty liver disease (NAFLD), chronic hepatitis B viral infection (HBV), alcoholic-related liver disease (ALD), primary biliary cholangitis (PBC), autoimmune hepatitis (AIH), and others. Skeletal muscle mass index (SMI) at one-year follow-up was not significantly different (p = .07), but loss of muscle mass was found in 31% of patients. The only variable that significantly differed between those that experienced muscle loss and those that did not was serum 25-hydroxyvitamin D levels (p = .0025). It appears that muscle loss was most prominent in patients with NAFLD (48.7%; p < .05), followed by ALD (28.6%), HBV/HCV (28.4%), and PBC/AIH (18.5%). The cutoff of ≥12.7 ng/mL for serum 25-hydroxyvitamin D levels was a significant predictor of muscle mass loss (p < .0001), complicated cirrhosis (p < .01), lower hemoglobin (p < .01), platelet counts (p < .01), prothrombin time (p < .01), and total cholesterol (p < .01). Gamma-glutamyl transpeptidase (GGT) levels were significantly lower in patients with 25-hydroxyvitamin D levels above the cutoff (p < .01). Levels ≥12.7 ng/mL were most strongly associated with muscle loss in patients with NAFLD. The results of this study indicate that low baseline 25-hydroxyvitamin D levels (<12.7 ng/mL) were independently associated with muscle loss, suggesting that this sequelae of chronic liver disease may be complicated by low vitamin D levels, with opportunities to attenuate this risk through early supplementation. Further longitudinal studies with larger cohorts will be required to confirm the generalizability of these results. 

Click to read the study in PLOSONE

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