The features of body composition in patients with arterial hypertension and metabolic dysfunction-associated steatotic liver disease and their association with physical activity: results of a single-center cross-sectional study

Objective. The purpose of this study was to establish the features of body composition and their association with functional activity in patients with arterial hypertension (HTN) and metabolic dysfunction-associated steatotic liver disease (MASLD).
Design and methods. The study included 133 patients of both sexes with HTN grade I-II and MAFLD. The average age of the study participants was 48,0 ± 7,99 years, including 58 women (46,6 %). All patients underwent anthropometric measurements, evaluation of muscle strength and function, as well as instrumental examinations. Quantitative determination of body composition (fat, fat-free, and bone mass) was performed using dual-energy X-ray absorptiometry. The short form of the International Physical Activity Questionnaire (IPAQ) was used to assess physical activity. Statistical analysis of the data was performed using the SPSS 27.0 statistical software package (IBM, USA). The differences between the indicators were considered significant at p < 0,05.
Results. Patients with HTN and MASLD had modified body composition with excessive fat tissue accumulation together with decreased muscle mass. Significant correlations were established between the increased fat mass, decreased muscle mass, muscle strength and disturbed muscle function, indicating a higher probability of the sarcopenic obesity in this category of patients.
Conclusion. Assessment of body composition, as well as early interventions aimed at increasing muscle mass and improving its structure and function, are key aspects in planning a set of medical prevention measures for patients with HTN and MASLD.

1. Antyukh KYu. Non-alcoholic fatty liver disease and cardiovascular risks. Emergency Cardiology and Cardiovascular Risks Journal. 2023;7(2):1991–1999. (In Russ.) https://doi.org/10.51922/2616-633X.2023.7.2.1991

2. Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335–1347. https://doi.org/10.1097/HEP.0000000000000004

3. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease — meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. https://doi.org/10.1002/hep.28431

4. Donati G, Stagni B, Piscaglia F, Venturoli N, Morselli-LabateAM, Rasciti L, et al. Increased prevalence of fatty liver in arterial hypertensive patients with normal liver enzymes: role of insulin resistance. Gut. 2004;53(7):1020–1023. https://doi.org/10.1136/gut.2003.027086

5. STEPS: Распространенность факторов риска неинфекционных заболеваний в Республике Беларусь, 2020 г. Копенгаген: Европейское региональное бюро ВОЗ; 2022. Лицензия: CC BY-NC-SA 3.0 IGO. STEPS: Prevalence of noncommunicable disease risk factors in the Republic of Belarus, 2020. Copenhagen: WHO Regional Office for Europe; 2022. License: CC BY-NC-SA 3.0 IGO.

6. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;78(6):1966–1986. https://doi.org/10.1097/HEP.0000000000000520

7. Sheptulina AF, Yafarova AA, Mamutova EM, Drapkina OM. Sonographic features of rectus femoris muscle in patients with metabolic dysfunction-associated fatty liver disease and their correlation with body composition parameters and muscle strength: results of a single-center cross-sectional study. Biomedicines. 2024;12(8):1684. https://doi.org/10.3390/biomedicines12081684

8. Samoilova IuG, Matveeva MV, Khoroshunova EA, Kudlay DA, Tolmachev IV, Spirina LV, et al. Body composition in sarcopenia in middle-aged individuals. Terapevticheskii Arkhiv. 2022;94(10):1149–1154. (In Russ.) https://doi.org/10.26442/00403660.2022.10.201878

9. da Costa Teixeira LA, Soares LA, da Fonseca SF, dos Santos JM, Viegas ÂA, et al. Analysis of body composition, functionality and muscle-specific strength of older women with obesity, sarcopenia and sarcopenic obesity: a cross-sectional study. Sci Rep. 2024;14:24802. https://doi.org/10.1038/s41598-024-76417-7

10. Batsis JA, Mackenzie TA, Emeny RT, Lopez-Jimenez F, Bartels SJ. Low lean mass with and without obesity, and mortality: results from the 1999–2004 national health and nutrition examination survey. J Gerontol A Biol Sci Med Sci. 2017;72(10):1445–1451. https://doi.org/10.1093/gerona/glx002

11. Mikaelyan AA, Varaeva YR, Liskova YV, Kislyak OA, Kosyura SD, Zolkina IV, et al. Sarcopenic obesity and the sarcopenia index in elderly women with arterial hypertension and visceral obesity. Effektivnaya Farmakoterapiya. 2024;20(51):34-41. (In Russ.) https://doi.org/10.33978/2307-3586-2024-20-51-34-41

12. Kurmaev DP, Bulgakova SV, Treneva EV. Sarcopenic obesity — a current problem of modern geriatrics. Russian Journal of Geriatric Medicine. 2022;(4):228–235. (In Russ.) https://doi.org/10.37586/2686-8636-4-2022-228-235

13. Antyukh KYu, Grigorenko EA, Vasilyeva NA, Semenova NV, Kolyadko MG, Gevorkyan TT, et al. Sarcopenic obesity in patients with arterial hypertension and metabolic dysfunction-associated steatotic liver disease: focus on inflammation. Part 1. Emergency Cardiology and Cardiovascular Risks Journal. 2025;9(1):2390–2403. https://doi.org/10.51922/2616-633X.2025.9.1.2390

14. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, et al. The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006;6:33. https://doi.org/10.1186/1471-25.230X-6-33

15. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. https://doi.org/10.1093/ageing/afy169

16. Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Obes Facts. 2022;15(3):321–335. https://doi.org/10.1159/000521241

17. Ministry of Health of the Republic of Belarus. Clinical protocol "Diagnosis and treatment of patients with osteoporosis (adult population)": approved by the resolution of the Ministry of Health of the Republic of Belarus on 21.06.2021 No. 85 [Internet]. Minsk: National Legal Internet Portal of the Republic of Belarus; 2021 [cited 2024 Sep 28]. p. 127–128. Available from: https://pravo.by/document/?guid=12551&p0=W22238190p

18. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–423. https://doi.org/10.1093/ageing/afq034

19. de Fátima Ribeiro Silva C, Ohara DG, Matos AP, Pinto ACPN, Pegorari MS. Short physical performance battery as a measure of physical performance and mortality predictor in older adults: a comprehensive literature review. Int J Environ Res Public Health. 2021;18(20):10612. https://doi.org/10.3390/ijerph182010612

20. Antyukh КYu, Grigorenko EA, Sheptulina АF, Drapkina ОM, Mitkovskaya NP. Osteosarcopenia and arterial hypertension: current approaches to the problem. Emergency Cardiology and Cardiovascular Risks Journal. 2023;7(1):1868–1875. (In Russ.) https://doi.org/10.51922/2616-633X.2023.7.1.1868

21. van Poppel, MNM, Chinapaw MJM, Mokkink LB, van Mechelen W, Terwee CB. Physical activity questionnaires for adults: a systematic review of measurement properties. Sports Med. 2010;40(7):565–600. https://doi.org/10.2165/11531930-000000000-00000

22. Scott D, Blyth F, Naganathan V, Le Couteur DJ, Handelsman DJ, Waite LM, et al. Sarcopenia prevalence and functional outcomes in older men with obesity: comparing the use of the EWGSOP2 sarcopenia versus ESPEN-EASO sarcopenic obesity consensus definitions. Clin. Nutr. 2023;42(9):1610–1618. https://doi.org/10.1016/j.clnu.2023.07.014

23. Sheptulina AF, Lyusina EO, Mamutova EM, YafarovaAA, Kiselev AR, Drapkina OM. Bioelectrical impedance analysis demonstrates reliable agreement with dual-energy x-ray absorptiometry in identifying reduced skeletal muscle mass in patients with metabolic dysfunction-associated steatotic liver disease and hypertension. Diagnostics. 2024;14:2301. https://doi.org/10.3390/diagnostics14202301

24. Dadaeva VA, Eganian RA, Kupreishvili LV, Orlova AS, Drapkina OM. Body composition in patients with metabolic syndrome. Russian Journal of Preventive Medicine. 2020;23(3):69–75. (In Russ.) https://doi.org/10.17116/profmed20202303169

25. Kim G, Lee SE, Lee YB, Jun JE, Ahn J, Bae JC, et al. Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a 7-year longitudinal study. Hepatology. 2018;68(5):1755–1768. https://doi.org/10.1002/hep.30049

26. Nijholt W, Scafoglieri A, Jager-Wittenaar H, Hobbelen JSM, van der Schans CP. The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle. 2017;8(5):702–712. https://doi.org/10.1002/jcsm.12210

27. Mainous AG 3rd, Rooks BJ, Medley JF, Dickmann SB. Body composition among adults at a healthy body mass index and association with undetected non-alcoholic fatty liver. Int J Obes (Lond). 2022;46(7):1403–1405. https://doi.org/10.1038/s41366-022-01124-0

28. Ariya M, Koohpayeh F, Ghaemi A, Osati S, Davoodi SH, Razzaz JM, et al. Assessment of the association between body composition and risk of non-alcoholic fatty liver. PLoS One. 2021;16(4):e0249223. https://doi.org/10.1371/journal.pone.0249223

29. Liu C, Cheng KY, Tong X, Cheung WH, Chow SK, Law SW, et al. The role of obesity in sarcopenia and the optimal body composition to prevent against sarcopenia and obesity. Front Endocrinol (Lausanne). 2023;14:1077255. https://doi.org/10.3389/fendo.2023.1077255

30. Schneider CV, Zandvakili I, Thaiss CA, Schneider KM. Physical activity is associated with reduced risk of liver disease in the prospective UK Biobank cohort. JHEP Rep. 2021;3(3):100263. https://doi.org/10.1016/j.jhepr.2021.100263

31. Qin H, Jiao W. Correlation of muscle mass and bone mineral density in the NHANES US general population, 2017–2018. Medicine (Baltimore). 2022;101(39):e30735. https://doi.org/10.1097/MD.0000000000030735

32. Pan Y, Xu J. Association between muscle mass, bone mineral density and osteoporosis in type2 diabetes. J Diabetes Investig. 2022;13(2):351–358. https://doi.org/10.1111/jdi.13642

33. Verschueren S, Gielen E, O'Neill TW, Pye SR, Adams JE, Ward KA, et al. Sarcopenia and its relationship with bone mineral density in middle-aged and elderly European men. Osteoporos Int. 2013;24(1):87–98. https://doi.org/10.1007/s00198-012-2057-z

34. Arruan W, Bukhari A, Handayani ND, Taslim NA, Faradilah A, Aminuddin. The relationship of physical activity with nutritional status and body composition in traditional and modern populations in South Sulawesi, Indonesia. Nutricion Clinica y Dietetica Hospitalaria. 2024;44(3):204–211. https://doi.org/10.12873/443arruan

35. Tehard B, Saris WH, Astrup A, Martinez JA, Taylor MA, Barbe P, et al. Comparison of two physical activity questionnaires in obese subjects: the NUGENOB study. Med Sci Sports Exerc. 2005;37(9):1535–1541. https://doi.org/10.1249/01.mss