Myosteatosis tied to adiposity, mortality in CKD patients

03 Jun 2025 byStephen Padilla
Myosteatosis tied to adiposity, mortality in CKD patients

Old age, abdominal obesity, and metabolic dysfunction are independently associated with increased myosteatosis, which also contributes to a higher risk of mortality, in patients with chronic kidney disease (CKD), according to a study.

In multiple linear regression analysis, the two parameters of myosteatosis, mean muscle attenuation and percentage of intermuscular adipose tissue (%IMAT) within the skeletal muscle area (SMA), showed independent associations with age, metabolic syndrome, and abdominal adipose tissue (muscle attenuation model: adjusted R2, 0.535; p<0.001; %IMAT model: adjusted R2, 0.462; p<0.001).

In addition, higher %IMAT and lower attenuation both correlated with an increased risk of death. [Eur J Clin Nutr 2025;79:475-483]

"In patients with CKD, the extent of CT-assessed abdominal myosteatosis was associated with higher age, abdominal adiposity, and markers of metabolic dysfunction,” the researchers said. “Moreover, in the adjusted analysis, higher %IMAT and lower attenuation were associated with a higher mortality risk.”

On the other hand, no association was observed between creatinine clearance and myosteatosis. However, no assessment was done on the changes in renal function over time, and this prevented any confirmation of previous findings, according to the researchers.

“Nevertheless, individuals with CKD often have several conditions already associated with myosteatosis,” they said. “Available evidence suggests that ageing, poor nutritional status, inflammation, oxidative stress, mitochondrial dysfunction, and insulin resistance might act synergistically in the development of myosteatosis.” [Nephrology 2010;15:454-463]

Obesity

Another factor associated with myosteatosis in CKD patients was obesity. A previous study found a link between myosteatosis and other markers of body composition in patients on haemodialysis. [Clin Nutr 2023;42:1359-1368] 

Among the four body composition phenotypes (ie, normal, sarcopenia only, obesity only, and sarcopenic obesity) in the said study, the two obesity groups showed the highest prevalence of myosteatosis relative to the normal body composition group. [Clin Nutr 2023;42:1359-1368]

“Research involving other patient populations, as well as healthy individuals, further supports a link between obesity and its associated metabolic disturbances and the occurrence of myosteatosis,” the researchers said. [Diabetes Metab J 2021;45:482-491; Metabolism 2018;85:205-212; Med Sci Sports Exerc 2018;50:1495-1501]

“One possible explanation for this association is that with increased adiposity, adipocytes may exceed their fat-storage capacity, resulting in the accumulation of ectopic fat in lean tissues, including skeletal muscle, liver, and pancreas,” they added. [Endocrinol Metab 2021;36:1161-1174]

Participants

The current study included 216 patients (mean age 60.3 years, 63 percent men) with CKD stages 3–5. Their body composition was assessed using abdominal CT scans at the third lumbar vertebra (L3). Abdominal obesity was identified via abdominal adipose tissue and sarcopenia by low SMA and low handgrip strength.

Two parameters were used to assess myosteatosis, namely mean muscle attenuation and %IMAT within SMA. The researchers explored the relationship of these parameters with demographic, clinical, and metabolic variables. They also fitted a multiple linear regression model to identify the predictors of myosteatosis. Finally, Cox regression analysis was used to assess the risk of mortality.

“Myosteatosis is defined as an ectopic deposition of adipose tissue in the skeletal muscle between muscle fibres or within muscle fibres and myocytes,” the researchers said. [Front Physiol 2020;11:963]

“Myosteatosis has a direct effect on muscle quality by diminishing muscle contractile capacity and reducing muscle function and strength, regardless of muscle quantity,” they added. [Int J Endocrinol 2014;2014:309570; Endocrinol Metab 2021;36:1161-1174]