Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis.
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis.
JAMA Netw Open. 2023 Oct 2;6(10):e2338952. doi: 10.1001/jamanetworkopen.2023.38952.
Physical activity (PA) is recommended for preventing and treating nonalcoholic fatty liver disease (NAFLD). Yet, how long-term patterns of intensity-based physical activity, including moderate-intensity PA (MPA) and vigorous-intensity PA (VPA), might affect the prevalence of NAFLD in middle age remains unclear.
To identify distinct intensity-based PA trajectories from young to middle adulthood and examine the associations between PA trajectories and NAFLD prevalence in midlife.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort of 2833 participants used the Coronary Artery Risk Development in Young Adults study data. The setting included field clinics in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. Data analysis was completed in March 2023.
PA was self-reported at 8 examinations over 25 years (1985-1986 to 2010-2011) and separately scored for MPA and VPA.
NAFLD was defined as liver attenuation values less than 51 Hounsfield units after exclusion of other causes of liver fat, measured using computed tomography in year 25 (2010-2011).
Among a total of 2833 participants included in the sample, 1379 (48.7%) self-identified as Black, 1454 (51.3%) as White, 1206 (42.6%) as male, and 1627 (57.4%) as female from baseline (1985-1986) (mean [SD] age, 25.0 [3.6] years) to year 25 (2010-2011) (mean [SD] age, 50.1 [3.6] years). Three MPA trajectories were identified: very low stable (1514 participants [53.4%]), low increasing (1096 [38.7%]), and moderate increasing (223 [7.9%]); and 3 VPA trajectories: low stable (1649 [58.2%]), moderate decreasing (1015 [35.8%]), and high decreasing (169 [6.0%]). After adjustment for covariates (sex, age, race, study center, education, smoking status, and alcohol consumption), participants in the moderate decreasing (risk ratio [RR], 0.74; 95% CI, 0.54-0.85) and the high decreasing (RR, 0.59; 95% CI, 0.44-0.80) VPA trajectories had a lower risk of NAFLD in middle age, relative to participants in the low stable VPA trajectory. Adjustments for baseline body mass index and waist circumference attenuated these estimates, but the results remained statistically significant. The adjusted RRs across the MPA trajectories were close to null and not statistically significant.
This cohort study of Black and White participants found a reduced risk of NAFLD in middle age for individuals with higher levels of VPA throughout young to middle adulthood compared with those with lower VPA levels. These results suggest the need for promoting sustainable and equitable prevention programs focused on VPA over the life course to aid in lowering NAFLD risk.
体力活动（PA）被推荐用于预防和治疗非酒精性脂肪肝疾病（NAFLD）。然而，从中年到成年早期的长期强度型体力活动模式，包括中等强度体力活动（MPA）和剧烈强度体力活动（VPA），如何影响 NAFLD 的患病率仍不清楚。
确定从中年到成年早期的不同强度型体力活动轨迹，并研究 PA 轨迹与中年 NAFLD 患病率之间的关系。
设计、地点和参与者：本研究基于人群的 2833 名参与者使用了冠状动脉风险发展在年轻人研究数据。该研究的地点包括阿拉巴马州伯明翰、伊利诺伊州芝加哥、明尼苏达州明尼阿波利斯和加利福尼亚州奥克兰的现场诊所。数据分析于 2023 年 3 月完成。
PA 在 25 年的 8 次检查中（1985-1986 年至 2010-2011 年）进行了自我报告，并分别对 MPA 和 VPA 进行了评分。
NAFLD 定义为在排除其他肝脏脂肪原因后肝脏衰减值小于 51 亨氏单位，使用计算机断层扫描在第 25 年（2010-2011 年）进行测量。
在纳入样本的 2833 名参与者中，有 1379 名（48.7%）自我认定为黑人，1454 名（51.3%）为白人，1206 名（42.6%）为男性，1627 名（57.4%）为女性，从基线（1985-1986 年）（平均[标准差]年龄，25.0[3.6]岁）到第 25 年（2010-2011 年）（平均[标准差]年龄，50.1[3.6]岁）。确定了三种 MPA 轨迹：非常低的稳定（1514 名参与者[53.4%]）、低增加（1096 名[38.7%]）和中度增加（223 名[7.9%]）；以及三种 VPA 轨迹：低稳定（1649 名[58.2%]）、中度减少（1015 名[35.8%]）和高减少（169 名[6.0%]）。在调整了性别、年龄、种族、研究中心、教育、吸烟状况和饮酒量等混杂因素后，与低稳定 VPA 轨迹的参与者相比，中度减少（风险比[RR]，0.74；95%置信区间[CI]，0.54-0.85）和高减少（RR，0.59；95%CI，0.44-0.80）VPA 轨迹的参与者在中年时患 NAFLD 的风险较低。这些调整结果仍然具有统计学意义，但对基线身体质量指数和腰围的调整降低了这些估计值。在 MPA 轨迹中，调整后的 RR 接近零且不具有统计学意义。
本研究对黑人和白人参与者进行了队列研究，发现与低 VPA 水平的参与者相比，在年轻到中年期间，VPA 水平较高的个体患 NAFLD 的风险较低。这些结果表明，需要制定以 VPA 为重点的可持续和公平的预防计划，以帮助降低 NAFLD 的风险。
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