Physical activity linked with lower mortality in NAFLD

Objectively measured physical activity was associated with lower all-cause mortality in patients with non-alcoholic fatty liver disease, according to research published in Clinical Gastroenterology and Hepatology.

Donghee Kim, MD, PhD, of the division of gastroenterology and hepatology at Stanford University School of Medicine, and colleagues wrote that cardiovascular disease is the leading cause of mortality in patients with NAFLD due to the disease’s bidirectional association with metabolic syndrome.

“While there are currently no approved pharmacological agents to treat NAFLD, lifestyle modifications remain the cornerstone of management, albeit many find them challenging to implement and maintain,” they wrote. “Physical activity is a key component of lifestyle modification and is routinely recommended for individuals with NAFLD, alongside dietary consultation to facilitate weight loss and changes in body composition.”

Researchers analyzed data from the 2003 to 2006 United States Health and Nutrition Examination Survey to determine if physical activity is associated with all-cause and cardiovascular mortality in patients with NAFLD.

Investigators defined NAFLD based on hepatic steatosis index or U.S. fatty liver index scores in the absence of other causes of chronic liver disease. Patients wore accelerometers to measure physical activity, which was classified as total physical activity, moderate to vigorous physical activity and sedentary behavior.

After an average follow-up of 10.6 years, Kim and colleagues found that increasing duration of total physical activity was associated with reduced risk for all-cause mortality using an age- and sex-adjusted model (highest quartile vs. lowest quartile, HR = 0.52; 95% CI, 0.32-0.86). Increasing duration of moderate to vigorous physical activity was also associated with lower risk for all-cause mortality.

Additionally, longer total physical activity was associated with a lower risk for cardiovascular disease-related death (highest quartile vs. lowest quartile, HR = 0.28; 95% CI, 0.08-0.98). Increasing sedentary behavior had no impact on all-cause or cause-specific mortality.

“This population-based study suggests that increasing PA has beneficial survival effects on all-cause and cardiovascular disease-related mortality in individuals with NAFLD,” Kim and colleagues wrote. “These data suggest that recommendations to increase PA in patients with NAFLD should be explored as a potential treatment strategy.”