ImportanceThe association of moderate to vigorous physical activity (MVPA) with COVID-19 outcomes is unclear and needs to be investigated.ObjectiveTo identify the association of longitudinal changes in MVPA with SARS-CoV-2 infection and severe COVID-19 outcomes.Design, Setting, and ParticipantsThis nested case-control study used data from 6 396 500 adult patients in South Korean who participated in National Health Insurance Service (NHIS) biennial health screenings from period 1 (2017-2018) to period 2 (2019-2020). Patients were followed from October 8, 2020, until the diagnosis of COVID-19 or December 31, 2021.ExposureModerate to vigorous physical activity was measured by self-report on questionnaires during both NHIS health screenings and calculated by adding the frequency (times per week) of each moderate (≥30 minutes per day) and vigorous (≥20 minutes per day) physical activity.Main Outcomes and MeasuresThe main outcomes were a positive diagnosis of SARS-CoV-2 infection and severe COVID-19 clinical events. Adjusted odds ratio (aORs) and 99% CIs were calculated using multivariable logistic regression analysis.ResultsA total of 183 350 patients with COVID-19 (mean [SD] age, 51.9 [13.8] years; female, 89 369 [48.7%]; male, 93 981 [51.3%]) among 2 110 268 participants were identified. For participants with vs without COVID-19, the proportion of MVPA frequency at period 2 was 35.8% vs 35.9% for physically inactive, 18.9% vs 18.9% for 1 to 2 times per week, 17.7% vs 17.7% for 3 to 4 times per week, and 27.5% vs 27.4% for 5 or more times per week. Among unvaccinated, physically inactive patients at period 1, the odds for infection increased when engaged in MVPA 1 to 2 times per week (aOR, 1.08; 99% CI, 1.01-1.15), 3 to 4 times per week (aOR, 1.09; 99% CI, 1.03-1.16), or 5 or more times per week (aOR, 1.10; 99% CI, 1.04-1.17) at period 2. Conversely, among unvaccinated patients with MVPA of 5 or more times per week at period 1, the odds for infection decreased when engaged 1 to 2 times per week (aOR, 0.90; 99% CI, 0.81-0.98) or physically inactive (aOR, 0.80; 99% CI, 0.73-0.87) at period 2. The trend of MVPA and incident infection was mitigated when participants were fully vaccinated. Furthermore, the odds for severe COVID-19 showed significant but limited associations with MVPA.Conclusions and RelevanceThe findings of this nested case-control study show a direct association of MVPA with risk of SARS-CoV-2 infection, which was mitigated after completion of the COVID-19 vaccination primary series. In addition, higher levels of MVPA were associated with a lower risk of severe COVID-19 outcomes to limited proportions.
Background: Physical activity is known to have strong benefits on prevention and management of cardiovascular disease (CVD). Also, diabetes is known to increase the risk of cardiovascular disease-related morbidity and mortality. However, the evidence of association between changes in physical activity and risk of cardiovascular disease is limited, especially among patients with type 2 diabetes (T2DM). Methods: A total of 20,598 patients with newly diagnosed diabetes were extracted from the Korean National Health Insurance Service-Health Screening Cohort. Self-reported questionnaires using a 7-day recall method were used to assess physical activity and calculated in metabolic equivalent task (MET) score. Physical activity level was measured in the screening period Ⅰ (2009-10) and period Ⅱ (2011-12) and assessed the change in physical activity level with CVD risks. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using multivariable-adjusted Cox proportional hazards regression. Results: Compared with the patients from the screening period Ⅰ(2009-10) to period Ⅱ (2011-12), those who increased their physical activity level from sedentary to active showed a 35% lower risk of overall CVD risk (aHR 0.65, 95% CI 0.44-0.96). Inversely, those who decreased their physical activity level from active to sedentary showed a 79% higher risk of overall CVD risk (aHR 1.79, 95% CI 1.17-2.72). Conclusions: Among patients with newly diagnosed T2DM, change in physical activity showed an inverse relationship with CVD risk. Maintaining a modest level of physical activity is important in reducing CVD risk.
The prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to increase to over half of the adult population by 2040 globally. Since the final diagnosis of NAFLD is made by a liver biopsy, several non-invasive approaches have been developed and validated to define NAFLD and evaluate NAFLD-associated diseases. Presently, NAFLD has been identified as an important and independent risk factor for developing several extrahepatic diseases, including atherosclerosis, cardiovascular disease (CVD), diabetes, and dementia. This review discusses current findings of up-to-date literature regarding the effects of NAFLD on the risk of atherosclerosis and CVD in Asia along with potential underlying biological mechanisms and therapeutic approaches to lower the NAFLD-related CVD risk. We further focus on the difference between NAFLD and metabolic dysfunction-associated fatty liver disease (MAFLD) on the risk of CVD and its implication by comparing the risk of NAFLD and MAFLD.
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