Diet Quality and Physical Activity Affect Metabolic Dysfunction-associated Steatotic Liver Disease, Metabolic Dysfunction and Etiology-associated Steatohepatitis, and Compensated Advanced Chronic Liver Disease Among United States Adults: NHANES...

Overview

Journal Front Nutr

Date 2025 Jan 23

PMID 39845917

Authors

Peng Wang

Bingxin Xia

Shuang Wang

Affiliations

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Abstract

Background And Aim: Clinical data on the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction and etiology-associated steatohepatitis (MetALD) in a multi-ethnic U.S. population are limited. Additionally, the impact of physical activity (PA) and diet quality (DQ) on the risk of MASLD, MetALD, and compensated advanced chronic liver disease (cACLD) remains unclear. This study aimed to investigate the associations of PA and diet quality with the risks of MASLD, MetALD, and cACLD.

Methods And Results: This cross-sectional study analyzed data from 7,125 participants in the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Diet quality was assessed using the Healthy Eating Index-2015 (HEI-2015). PA was assessed based on the 2020 WHO Physical Activity Guidelines, with participants reporting the intensity, frequency, and duration of their activities over the past 7 days. MASLD and MetALD were diagnosed based on clinical criteria, and cACLD was defined by advanced liver fibrosis. Bivariate and multivariable logistic regression models were used to assess associations between PA, diet quality, and liver disease outcomes. The prevalence of MASLD and MetALD was 35.07 and 21.46%, respectively. HQD was associated with significantly lower risks of MASLD (OR: 0.49, 95% CI: 0.38-0.62) and MetALD (OR: 0.45, 95% CI: 0.36-0.56). High PA levels were linked to reduced risks of MASLD (OR: 0.47, 95% CI: 0.38-0.58) and MetALD (OR: 0.53, 95% CI: 0.39-0.72). The lowest risks for both MASLD and MetALD were observed in highly active participants with an HQD (MASLD OR: 0.41, 95% CI: 0.32-0.53; MetALD OR: 0.54, 95% CI: 0.41-0.71). Significant interactions were observed between PA, HQD, and age, BMI, and SES, which further reduced the risks of MASLD and MetALD. For cACLD, both increased PA and HQD were associated with reduced risk. Compared to non-high-activity participants with a non-HQD, physically active participants with an HQD had the lowest risk of cACLD (OR: 0.44, 95% CI: 0.24-0.82).

Conclusion: High proportions of the US population have MASLD or MetALD. HQD and high PA levels were associated with lower risks of MASLD, MetALD, and cACLD.

References

Pennisi G, Enea M, Romero-Gomez M, Bugianesi E, Wong V, Fracanzani A . Risk of liver-related events in metabolic dysfunction-associated steatohepatitis (MASH) patients with fibrosis: A comparative analysis of various risk stratification criteria. Hepatology. 2023; 79(4):912-925. DOI: 10.1097/HEP.0000000000000616. View

De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C . Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022; 76(4):959-974. PMC: 11090185. DOI: 10.1016/j.jhep.2021.12.022. View

Smith R, Soeters M, Wust R, Houtkooper R . Metabolic Flexibility as an Adaptation to Energy Resources and Requirements in Health and Disease. Endocr Rev. 2018; 39(4):489-517. PMC: 6093334. DOI: 10.1210/er.2017-00211. View

Alberti K, Zimmet P, Shaw J . The metabolic syndrome--a new worldwide definition. Lancet. 2005; 366(9491):1059-62. DOI: 10.1016/S0140-6736(05)67402-8. View

Aarts S, van den Akker M, Winkens B . The importance of effect sizes. Eur J Gen Pract. 2013; 20(1):61-4. DOI: 10.3109/13814788.2013.818655. View

Lee B, Dodge J, Terrault N . National prevalence estimates for steatotic liver disease and subclassifications using consensus nomenclature. Hepatology. 2023; 79(3):666-673. PMC: 11232657. DOI: 10.1097/HEP.0000000000000604. View

Kim G, Moon J, Kim W . Critical appraisal of metabolic dysfunction-associated steatotic liver disease: Implication of Janus-faced modernity. Clin Mol Hepatol. 2023; 29(4):831-843. PMC: 10577343. DOI: 10.3350/cmh.2023.0277. View

Chen T, Clark J, Riddles M, Mohadjer L, Fakhouri T . National Health and Nutrition Examination Survey, 2015-2018: Sample Design and Estimation Procedures. Vital Health Stat 2. 2021; (184):1-35. View

Mega A, Marzi L, Kob M, Piccin A, Floreani A . Food and Nutrition in the Pathogenesis of Liver Damage. Nutrients. 2021; 13(4). PMC: 8073814. DOI: 10.3390/nu13041326. View

10.

Tsunoda K, Kai Y, Uchida K, Kuchiki T, Nagamatsu T . Physical activity and risk of fatty liver in people with different levels of alcohol consumption: a prospective cohort study. BMJ Open. 2014; 4(8):e005824. PMC: 4127917. DOI: 10.1136/bmjopen-2014-005824. View

11.

Bull F, Al-Ansari S, Biddle S, Borodulin K, Buman M, Cardon G . World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020; 54(24):1451-1462. PMC: 7719906. DOI: 10.1136/bjsports-2020-102955. View

12.

Siddiqui M, Vuppalanchi R, Van Natta M, Hallinan E, Kowdley K, Abdelmalek M . Vibration-Controlled Transient Elastography to Assess Fibrosis and Steatosis in Patients With Nonalcoholic Fatty Liver Disease. Clin Gastroenterol Hepatol. 2018; 17(1):156-163.e2. PMC: 6203668. DOI: 10.1016/j.cgh.2018.04.043. View

13.

Chen L, Tao X, Zeng M, Mi Y, Xu L . Clinical and histological features under different nomenclatures of fatty liver disease: NAFLD, MAFLD, MASLD and MetALD. J Hepatol. 2023; 80(2):e64-e66. DOI: 10.1016/j.jhep.2023.08.021. View

14.

Milosevic I, Vujovic A, Barac A, Djelic M, Korac M, Radovanovic Spurnic A . Gut-Liver Axis, Gut Microbiota, and Its Modulation in the Management of Liver Diseases: A Review of the Literature. Int J Mol Sci. 2019; 20(2). PMC: 6358912. DOI: 10.3390/ijms20020395. View

15.

Cornide-Petronio M, Isabel Alvarez-Mercado A, Jimenez-Castro M, Peralta C . Current Knowledge about the Effect of Nutritional Status, Supplemented Nutrition Diet, and Gut Microbiota on Hepatic Ischemia-Reperfusion and Regeneration in Liver Surgery. Nutrients. 2020; 12(2). PMC: 7071361. DOI: 10.3390/nu12020284. View

16.

Vilar-Gomez E, Nephew L, Vuppalanchi R, Gawrieh S, Mladenovic A, Pike F . High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population. Hepatology. 2021; 75(6):1491-1506. DOI: 10.1002/hep.32207. View

17.

Kang H . Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof. 2021; 18:17. PMC: 8441096. DOI: 10.3352/jeehp.2021.18.17. View

18.

Krebs-Smith S, Pannucci T, Subar A, Kirkpatrick S, Lerman J, Tooze J . Update of the Healthy Eating Index: HEI-2015. J Acad Nutr Diet. 2018; 118(9):1591-1602. PMC: 6719291. DOI: 10.1016/j.jand.2018.05.021. View

19.

Nicoll R, Gerasimidis K, Forrest E . The Role of Micronutrients in the Pathogenesis of Alcohol-Related Liver Disease. Alcohol Alcohol. 2021; 57(3):275-282. DOI: 10.1093/alcalc/agab060. View

20.

Eslam M, Sanyal A, George J . MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020; 158(7):1999-2014.e1. DOI: 10.1053/j.gastro.2019.11.312. View