Clustering of lifestyle behaviours and analysis of their associations with MAFLD: a cross-sectional study of 196,515 individuals in China

Abstract

Background The aggregation of lifestyle behaviours and their association with metabolic-associated fatty liver disease (MAFLD) remain unclear. We identified lifestyle patterns and investigated their association with the risk of developing MAFLD in a sample of Chinese adults who underwent annual physical examinations. Methods Annual physical examination data of Chinese adults from January 2016 to December 2020 were used in this study. We created a scoring system for lifestyle items combining a statistical method (multivariate analysis of variance) and clinical expertise (Delphi method). Subsequently, principal component analysis and two-step cluster analysis were implemented to derive the lifestyle patterns of men and women. Binary logistic regression analysis was used to explore the prevalence risk of MAFLD among lifestyle patterns stratified by sex. Results A total of 196,515 subjects were included in the analysis. Based on the defined lifestyle scoring system, nine and four lifestyle patterns were identified for men and women, respectively, which included “healthy or unhealthy” patterns and mixed patterns containing a combination of healthy and risky lifestyle behaviours. This study showed that subjects with an unhealthy or mixed pattern had a significantly higher risk of developing MAFLD than subjects with a relatively healthy pattern, especially among men. Conclusions Clusters of unfavourable behaviours are more prominent in men than in women. Lifestyle patterns, as important factors influencing the development of MAFLD, show significant sex differences in the risk of MAFLD. There is a strong need for future research to develop targeted MAFLD interventions based on the identified behavioural clusters by sex stratification.

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“…Based on analysis of approximately 200000 individuals in China, Zhou et al [ 11 ], found a significantly higher prevalence of MAFLD in men than in women (54.37% vs 20.88%). Additionally, fewer than 20% of men conducted a healthy lifestyle pattern as opposed to more than 90% of women[ 11 ].…”

“…Based on analysis of approximately 200000 individuals in China, Zhou et al [ 11 ], found a significantly higher prevalence of MAFLD in men than in women (54.37% vs 20.88%). Additionally, fewer than 20% of men conducted a healthy lifestyle pattern as opposed to more than 90% of women[ 11 ]. This study confirms that NAFLD is more common among men than in pre-menopausal women and that, after menopause, women lose this “protection” from developing NAFLD[ 12 ].…”