Unit of Lifestyle Medicine in Obesity and Diabetes, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Internal Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
Am J Gastroenterol. 2019 Jun;114(6):907-915. doi: 10.14309/ajg.0000000000000168.
We examined the dose-dependent association of habitual moderate-to-vigorous physical activity (MVPA) with the biochemical markers for nonalcoholic fatty liver disease (NAFLD) and whether this association changes with age and degree of impaired glucose metabolism. We also investigated whether the associations depend on the domain of MVPA.
In this study, using data from the population-based Lifelines cohort (N = 42,661), MVPA was self-reported on the short questionnaire to assess health-enhancing physical activity. NAFLD was defined as a fatty liver index value of >60, based on body mass index, waist circumference, plasma triglycerides, and gamma-glutamyltransferase. Glucose metabolism was defined as normal (NGM), impaired (IGM), and type 2 diabetes mellitus (T2DM). Exclusion criteria were previously diagnosed hepatitis or cirrhosis and excessive alcohol use. All analyses were adjusted for age, sex, and education.
Higher MVPA was dose dependently associated with a lower risk of having NAFLD: compared with "No MVPA," the odds ratios (ORs) (95% confidence intervals) for MVPA quintiles were 0.78 (0.71-0.86), 0.64 (0.58-0.70), 0.53 (0.48-0.59), 0.51 (0.46-0.56), and 0.45 (0.41-0.50) for the highest level of MVPA. The association between MVPA and NAFLD was stronger for more impaired glucose status (ORNGM = 0.49 (0.42-0.57), ORIGM = 0.46 (0.40-0.54), ORT2DM = 0.42 (0.27-0.66)) and for older age (OR20-40 years = 0.51 (0.42-0.62), OR60-80 years = 0.37 (0.29-0.48)) with the highest level of MVPA, relative to No MVPA. No favorable association was observed for occupational MVPA. With regard to MVPA and fibrosis, associations with fibrosis markers showed contradictory results.
Higher MVPA levels are dose dependently associated with a lower NAFLD risk. This association is stronger in people with diabetes and older adults.
我们研究了习惯性中高强度体力活动（MVPA）与非酒精性脂肪性肝病（NAFLD）生化标志物的剂量依赖性关联，以及这种关联是否随年龄和葡萄糖代谢受损程度而变化。我们还研究了这些关联是否取决于 MVPA 的领域。
在这项研究中，我们使用了基于人群的 Lifelines 队列（N=42661）的数据，通过短问卷自我报告 MVPA，以评估促进健康的体力活动。NAFLD 定义为根据体重指数、腰围、血浆甘油三酯和γ-谷氨酰转移酶计算的脂肪肝指数值>60。葡萄糖代谢定义为正常（NGM）、受损（IGM）和 2 型糖尿病（T2DM）。排除标准为既往诊断为肝炎或肝硬化和过量饮酒。所有分析均调整了年龄、性别和教育程度。
更高水平的 MVPA 与 NAFLD 的风险呈剂量依赖性降低相关：与“无 MVPA”相比，MVPA 五分位数的比值比（OR）（95%置信区间）分别为 0.78（0.71-0.86）、0.64（0.58-0.70）、0.53（0.48-0.59）、0.51（0.46-0.56）和 0.45（0.41-0.50），MVPA 水平最高。MVPA 与 NAFLD 的关联在葡萄糖代谢受损程度更高（ORNGM=0.49（0.42-0.57）、ORIGM=0.46（0.40-0.54）、ORT2DM=0.42（0.27-0.66））和年龄较大（OR20-40 岁=0.51（0.42-0.62）、OR60-80 岁=0.37（0.29-0.48））时更强，与无 MVPA 相比，MVPA 水平最高。职业性 MVPA 没有显示出有利的关联。关于 MVPA 和纤维化，与纤维化标志物的关联结果相互矛盾。
更高水平的 MVPA 与较低的 NAFLD 风险呈剂量依赖性相关。这种关联在糖尿病患者和老年人中更强。
