Quality Matters as Much as Quantity of Skeletal Muscle: Clinical Implications of Myosteatosis in Cardiometabolic Health

Abstract

Although age-related changes in skeletal muscles are closely associated with decreases in muscle strength and functional decline,their associations with cardiometabolic diseases in the literature are inconsistent. Such inconsistency could be explained by the factthat muscle quality—which is closely associated with fatty infiltration of the muscle (i.e., myosteatosis)—is as important as musclequantity in cardiometabolic health. However, muscle quality has been less explored compared with muscle mass. Moreover, the standard definition of myosteatosis and its assessment methods have not been established yet. Recently, some techniques using single axial computed tomography (CT) images have been introduced and utilized in many studies, as the mass and quality of abdominal muscles could be measured opportunistically on abdominal CT scans obtained during routine clinical care. Yet, the mechanisms by whichmyosteatosis affect metabolic and cardiovascular health remain largely unknown. In this review, we explore the recent advances inthe assessment of myosteatosis and its changes associated with aging. We also review the recent literature on the clinical implicationof myosteatosis by focusing on metabolic and cardiovascular diseases. Finally, we discuss the challenges and unanswered questionsthat need addressing to set myosteatosis as a therapeutic target for the prevention or treatment of cardiometabolic diseases.