Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China.
Front Endocrinol (Lausanne). 2024 Jul 25;15:1375374. doi: 10.3389/fendo.2024.1375374. eCollection 2024.
BACKGROUND & AIMS: Accumulating studies have demonstrated associations between single lifestyle exposures and metabolic dysfunction-associated fatty liver disease (MAFLD). However, the joint effects of lifestyle exposures remain unclear, hindering the development of targeted prevention and control strategies. We aimed to investigate the joint associations between lifestyle exposomes and MAFLD. METHODS: This study included 5,002 participants from NHANES 2017-2020. Lifestyle exposomes, including sleep duration, metabolic equivalent of task (MET), Healthy Eating Index (HEI)-2015 score, alcohol consumption, and smoke exposure, were identified from questionnaire data. MAFLD was diagnosed by vibration-controlled transient elastography measurements and laboratory data. A logistic regression model and the weighted quantile sum method were used to evaluate the associations of single and joint lifestyle exposomes, respectively, with MAFLD. The population attributable fractions (PAFs) were calculated to assess the population benefits of different intervention strategies. RESULTS: Per-quartile range increases in sleep duration (OR=0.883, 95% CI: 0.826-0.944), MET (0.916, 0.871-0.963), and HEI-2015 score (0.827, 0.756-0.904) were significantly associated with MAFLD. The joint exposure of sleep duration, MET, and HEI-2015 score was associated with MAFLD (0.772, 0.688-0.865), with the highest weight (importance) for MET (0.526). PAFs revealed greater intervention benefits for sleep and the HEI-2015 when the majority of the population (>5%) had a low MAFLD risk (weak intervention targets), whereas MET was the most efficient intervention strategy when minority populations (≤5%) had a low MAFLD risk (strong intervention targets). CONCLUSION: This study demonstrated significant associations between MAFLD and single and joint exposures to sleep duration, MET, and HEI-2015 and identified physical activity as the most important lifestyle factor. Further population benefit analyses may provide evidence and suggestions for population-level interventions.
背景与目的：越来越多的研究表明，单一生活方式暴露与代谢相关脂肪性肝病（MAFLD）之间存在关联。然而，生活方式暴露的联合效应尚不清楚，这阻碍了有针对性的预防和控制策略的制定。我们旨在研究生活方式暴露组与 MAFLD 之间的联合关联。
方法：本研究纳入了来自 NHANES 2017-2020 年的 5002 名参与者。通过问卷数据确定了生活方式暴露组，包括睡眠时长、代谢当量（MET）、健康饮食指数（HEI）-2015 评分、饮酒和吸烟暴露。通过振动控制瞬态弹性成像测量和实验室数据诊断 MAFLD。使用逻辑回归模型和加权分位数总和法分别评估单一生活方式暴露组和联合生活方式暴露组与 MAFLD 的关联。计算人群归因分数（PAF）以评估不同干预策略的人群获益。
结果：睡眠时长（比值比=0.883，95%可信区间：0.826-0.944）、MET（0.916，0.871-0.963）和 HEI-2015 评分（0.827，0.756-0.904）每增加一个四分位间距与 MAFLD 显著相关。睡眠时长、MET 和 HEI-2015 评分的联合暴露与 MAFLD 相关（0.772，0.688-0.865），其中 MET 的权重（重要性）最高（0.526）。PAF 表明，对于大多数人群（>5%） MAFLD 风险较低（弱干预目标），睡眠和 HEI-2015 的干预获益更大，而对于少数人群（≤5%） MAFLD 风险较低（强干预目标），MET 是最有效的干预策略。
结论：本研究表明，MAFLD 与睡眠时长、MET 和 HEI-2015 的单一和联合暴露之间存在显著关联，并确定了身体活动是最重要的生活方式因素。进一步的人群获益分析可能为人群干预提供证据和建议。
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