High‐quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population

Vilar‐Gomez, Eduardo; Nephew, Lauren; Vuppalanchi, Raj; Gawrieh, Samer; Mladenovic, Andrea; Pike, Francis; Samala, Niharika; Chalasani, Naga

doi:10.1002/hep.32207

Cited by 108 publications

(59 citation statements)

References 32 publications

(63 reference statements)

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“…An inverse association between physical activity and NAFLD risk was observed in a meta-analysis including 6 cohort and 4 case–control studies [ 36 ] and subsequent studies [ 37 , 38 ]. Compared with individuals with lowest physical activity levels, those with highest levels (similar to vigorous physical activity) had a lower odds of developing NAFLD (risk ratio, 0.79; 95% CI 0.71, 0.89) [ 36 ].…”

Section: Discussionmentioning

confidence: 98%

Lifestyle and metabolic factors for nonalcoholic fatty liver disease: Mendelian randomization study

Yuan

Chen

et al. 2022

Eur J Epidemiol

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The risk factors for nonalcoholic fatty liver disease (NAFLD) have not been clearly identified. We conducted a Mendelian randomization (MR) study to explore this. Independent genetic variants strongly associated with 5 lifestyle and 9 metabolic factors were selected as instrumental variables from corresponding genome-wide association studies (GWASs). Summary-level data for NAFLD were obtained from a GWAS meta-analysis of 8434 cases and 770,180 non-cases (discovery dataset) and another GWAS meta-analysis of 1483 cases and 17,781 non-cases (replication dataset). Univariable and multivariable MR analyses were performed. There were associations with NAFLD for lifetime smoking index (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.31–1.93 per SD-increase), body mass index (BMI, OR 1.33, 95% CI 1.23–1.43 per SD-increase), waist circumference (OR 1.82; 95% CI 1.48–2.24 per SD-increase), type 2 diabetes (OR 1.21, 95% CI 1.15–1.27 per unit increase in log-transformed odds), systolic blood pressure (OR 1.17; 95% CI 1.07–1.26 per 10 mmHg increase), high-density lipoprotein cholesterol (OR 0.84, 95% CI 0.77–0.90 per SD-increase), and triglycerides (OR 1.23, 95% CI 1.15–1.33 per SD-increase). The associations for type 2 diabetes, systolic blood pressure, triglycerides, but not for high-density lipoprotein cholesterol remained strong after adjusting for genetically-predicted BMI. Genetic liability to type 2 diabetes mediated 51.4% (95% CI 13.4–89.3%) of the BMI-effects on NAFLD risk. There were suggestive inverse associations of genetically-predicted alcohol, coffee, and caffeine consumption, and vigorous physical activity with NAFLD risk. This study identified several lifestyle and metabolic factors that may be causally implicated in NAFLD.

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Section: Discussionmentioning

confidence: 98%

Lifestyle and metabolic factors for nonalcoholic fatty liver disease: Mendelian randomization study

Yuan

Chen

et al. 2022

Eur J Epidemiol

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“…[ 41 ] Only recently, a study identified lower risk of NAFLD in patients with higher education, partially mediated by a better diet quality and physical activity. [ 42 ] In this regard, HS may reflect lower socioeconomic status in PLWH.…”

Section: Discussionmentioning

confidence: 99%

Effect of hepatic steatosis and associated metabolic comorbidities on health‐related quality of life in people living with HIV

et al. 2022

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Hepatic steatosis (HS) related to nonalcoholic fatty liver disease (NAFLD) is increasing globally. In people living with human immunodeficiency virus (PLWH) risk factors of HS are increased. The impact of HS on outcomes and in particular health‐related quality of life (HRQL) in PLWH remains unknown. The aim of this cross‐sectional cohort study (FLASH, Prevalence of Advanced Fibrosis in Patients Living With HIV) was to determine the contribution of HS on HRQL in PLWH and to identify confounders on HRQL. A total of 245 PLWH were prospectively enrolled. HS was assessed using vibration‐controlled transient elastography and defined as a controlled attenuation parameter (CAP) of ≥ 275 dB/m. The analysis was performed between CAP < 275 and ≥ 275 dB/m. The generic European Quality‐of‐Life 5‐Dimension 5‐Level questionnaire was used to determine differences in the HRQL. Univariable and multivariable linear regression models were applied to identify predictors with impaired HRQL in both groups. In this cohort, 65% (n = 160) presented without and 35% (n = 85) with HS, of whom most had NAFLD (n = 65, 76.5%). The HRQL (UI‐value) was significantly lower in PLWH and steatosis (0.86 ± 0.18) in comparison with no steatosis (0.92 ± 0.13). Unemployment (p = 0.025) and waist circumference (p = 0.017) remained independent predictors of a poor HRQL in the steatosis subgroup. In turn, age (p = 0.045), female sex (p = 0.030), body mass index (p = 0.010), and arterial hypertension (p = 0.025) were independent predictors of a low HRQL in the subgroup without steatosis. Conclusion: HS and metabolic comorbidities negatively affect the HRQL. Addressing these factors may improve patient‐reported and liver‐related outcomes in PLWH.

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“…Lower cholesterol among persons with fibrosis was previously reported using earlier NHANES data. 13,43 In the current analysis we also examined lifestyle factors and found that persons with fatty liver disease were less likely to meet physical activity guidelines, more likely to be sedentary for 12 or more hours a day, and self-reported a less healthy diet. Fatty liver disease prevalence was highest among persons with both a lower level of physically activity and a higher level of sedentary behavior.…”

Section: Discussionmentioning

confidence: 92%

“…Beneficial effects of a healthier lifestyle on fatty liver disease and fibrosis were also reported in previous papers using NHANES 2017-2018 data. [12][13][14] Despite the potential benefit of lifestyle interventions across demographic groups, the COVID-19 pandemic has had a detrimental effect on lifestyle habits of less advantaged groups. A recent systematic review found decreased physical activity levels during the COVID-19 lockdown across almost all reviewed populations and increased sedentary behavior in the majority of studies included.…”

Section: Discussionmentioning

confidence: 99%

“…Increased physical activity is recommended along with a low calorie diet to achieve weight loss among persons with fatty liver disease despite limited information on the relationship of physical activity and diet with fatty liver disease in the general U.S. population. [12][13][14] Recently, the COVID-19 pandemic has augmented health disparities and imposes further challenges in implementation of these lifestyle improvements. A better understanding of social determinants of health, such as access to healthy food or places to exercise, may help to reduce health disparities and achieve health equity which may decrease the fatty liver disease burden among racial and ethnic minority and other underserved populations.…”

Section: Introductionmentioning

confidence: 99%

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Prepandemic prevalence estimates of fatty liver disease and fibrosis defined by liver elastography in the United States

Ruhl

2022

Preprint

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Background & AimsFatty liver disease is a growing public health burden with serious consequences. We estimated prepandemic prevalence of fatty liver disease determined by transient elastography assessed hepatic steatosis and fibrosis, and examined associations with lifestyle and other factors in a United States population sample.MethodsLiver stiffness and controlled attenuation parameter (CAP) were assessed on 7,923 non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and Hispanic men and women aged 20 years and over in the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 prepandemic data.ResultsThe prevalence of fatty liver disease estimated by CAP >300 dB/m was 28.8% and of fibrosis (liver stiffness >8 kPa) was 10.4%. Only 7.2% of participants with fatty liver disease and 10.9% with fibrosis reported being told by a health care provider that they had liver disease. In addition to known risk factors such as metabolic factors and ALT, persons with fatty liver disease were less likely to meet physical activity guidelines, more likely to be sedentary for 12 or more hours a day, and reported a less healthy diet. Persons with fibrosis were less likely to have a college degree and reported a less healthy diet.ConclusionIn the U.S. population, most persons with fatty liver disease are unaware of their condition. Although physical activity and dietary modifications might reduce the fatty liver disease burden, the COVID pandemic has been less favorable for lifestyle changes. There is an urgent need for fatty liver disease management in high-risk individuals using transient elastography or other noninvasive methods to intervene in disease progression.

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High‐quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population

Cited by 108 publications

References 32 publications

Lifestyle and metabolic factors for nonalcoholic fatty liver disease: Mendelian randomization study

Lifestyle and metabolic factors for nonalcoholic fatty liver disease: Mendelian randomization study

Effect of hepatic steatosis and associated metabolic comorbidities on health‐related quality of life in people living with HIV

Prepandemic prevalence estimates of fatty liver disease and fibrosis defined by liver elastography in the United States

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