Diabetes Metab J.  2024 Sep;48(5):971-982. 10.4093/dmj.2023.0133.

Healthy Lifestyle and the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease: A Large Prospective Cohort Study

• Chang Q
• Zhang Y
• Zhang T
• Liu Z
• Cao L
• Zhang Q
• Liu L
• Sun S
• Wang X
• Zhou M
• Jia Q
• Song K
• Ding Y
• Zhao Y
• Niu K
• Xia Y

• KMID: 2559006
• DOI: http://doi.org/10.4093/dmj.2023.0133

Abstract

Background
The incidence density of metabolic dysfunction-associated fatty liver disease (MAFLD) and the effect of a healthy lifestyle on the risk of MAFLD remain unknown. We evaluated the prevalence and incidence density of MAFLD and investigated the association between healthy lifestyle and the risk of MAFLD.
Methods
A cross-sectional analysis was conducted on 37,422 participants to explore the prevalence of MAFLD. A cohort analysis of 18,964 individuals was conducted to identify the incidence of MAFLD, as well as the association between healthy lifestyle and MAFLD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) with adjustments for confounding factors.
Results
The prevalence of MAFLD, non-alcoholic fatty liver disease, and their comorbidities were 30.38%, 28.09%, and 26.13%, respectively. After approximately 70 thousand person-years of follow-up, the incidence densities of the three conditions were 61.03, 55.49, and 51.64 per 1,000 person-years, respectively. Adherence to an overall healthy lifestyle was associated with a 19% decreased risk of MAFLD (HR, 0.81; 95% CI, 0.72 to 0.92), and the effects were modified by baseline age, sex, and body mass index (BMI). Subgroup analyses revealed that younger participants, men, and those with a lower BMI experienced more significant beneficial effects from healthy lifestyle.
Conclusion
Our results highlight the beneficial effect of adherence to a healthy lifestyle on the prevention of MAFLD. Health management for improving dietary intake, physical activity, and smoking and drinking habits are critical to improving MAFLD.

Keyword

Cross-sectional studies; Follow-up studies; Healthy lifestyle; Incidence; Non-alcoholic fatty liver disease; Prevalence

Figure

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  Fig. 1. Selection of study participants. MAFLD, metabolic dysfunction-associated fatty liver disease.

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  Fig. 2. The prevalence and incidence densities of metabolic dysfunction-associated fatty liver disease (MAFLD) and non-alcoholic fatty liver disease (NAFLD). (A) Prevalence. (B) Incidence density. A total of 37,422 participants were included in the prevalence calculations of MAFLD and NAFLD. A total of 18,964, 19,511, and 20,046 participants were included in the incidence density calculations of MAFLD, NAFLD, and the comorbidity of both, respectively.

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  Fig. 3. Associations between separated healthy lifestyle and the risk of metabolic dysfunction-associated fatty liver disease by age, sex, and body mass index (BMI) at baseline (n=18,964). Adjusted for age, sex, BMI, educational level, employment status, household income, energy intake per day, and family history of diseases (cardiovascular disease, hypertension, and diabetes) at baseline. HR, hazard ratio; CI, confidence interval.

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