CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai, 200031, PR China.
Shanghai Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 200438, China.
BMC Public Health. 2024 Nov 25;24(1):3264. doi: 10.1186/s12889-024-20663-x.
Metabolic dysfunction-associated fatty liver disease (MAFLD) affects up to one-third of the global population. Since no approved pharmacotherapy for MAFLD is available, lifestyle modification remains the cornerstone of clinical care. Our study aims to evaluate the association of an overall healthy lifestyle with MAFLD risk.
We conducted an analysis of 327,387 participants from UK biobank. An overall healthy lifestyle score including six evidence-based lifestyles (diet, alcohol consumption, physical activity, sedentary behavior, sleep, and smoking) was assessed by questionnaires. MAFLD and its subtypes were diagnosed by blood biochemistry, ICD codes, and medication information from touchscreen and verbal interview. The prevalence ratios (PRs) and risk ratios (RRs) were estimated by Poisson regression models with robust variance.
In the cross-sectional analysis, the PR (95% CI) was 0.83 (0.83 to 0.84) for MAFLD, and 0.83 (0.83 to 0.84) for MAFLD-overweight/obesity (MAFLD-O), 0.68 (0.66 to 0.70) for MAFLD-lean/normal weight and metabolic dysfunction (P-value for heterogeneity < 0.001), and 0.71 (0.71 to 0.72) for MAFLD-type 2 diabetes mellitus (MAFLD-T2D); and 0.68 (0.66 to 0.71) for dual (or more) etiology fatty liver disease (MAFLD-dual) and 0.83 (0.83 to 0.84) for single etiology MAFLD (MAFLD-single) (P-value for heterogeneity < 0.001) for one additional point in the overall healthy lifestyle score. During a median follow-up of 4.4 years, the RR (95% CI) was 0.83 (0.81 to 0.85) for MAFLD, and 0.83 (0.81 to 0.85) for MAFLD-O, 0.71 (0.62 to 0.81) for MAFLD-L, and 0.68 (0.64 to 0.72) for MAFLD-T2D (P-value for heterogeneity < 0.001); and 0.83 (0.81 to 0.85) for MAFLD-dual and 0.70 (0.58 to 0.85) for MAFLD-single (P-value for heterogeneity = 0.08) for one additional point in the overall healthy lifestyle score. These findings were validated in a prospective analysis among 15,721 participants with revisit data, and also supported by fatty liver index and proton density fat fraction data.
An overall healthy lifestyle that includes six evidence-based factors was strongly associated with lower MAFLD risk, especially the subtypes with multiple etiologies.
代谢相关脂肪性肝病（MAFLD）影响了全球三分之一的人口。由于目前尚无针对 MAFLD 的批准药物治疗方法，因此生活方式的改变仍然是临床治疗的基石。我们的研究旨在评估整体健康的生活方式与 MAFLD 风险的相关性。
我们对英国生物库中的 327387 名参与者进行了分析。通过问卷评估了包括 6 种基于证据的生活方式（饮食、饮酒、身体活动、久坐行为、睡眠和吸烟）的整体健康生活方式评分。MAFLD 及其亚型通过血液生化、ICD 编码和来自触摸屏和口头访谈的药物信息进行诊断。使用泊松回归模型和稳健方差估计患病率比（PR）和风险比（RR）。
在横断面分析中，MAFLD 的 PR（95%CI）为 0.83（0.83 至 0.84），MAFLD-超重/肥胖的 PR 为 0.83（0.83 至 0.84），MAFLD-正常体重和代谢功能障碍的 PR 为 0.68（0.66 至 0.70）（异质性 P 值<0.001），MAFLD-2 型糖尿病的 PR 为 0.71（0.71 至 0.72）；MAFLD-双重（或更多）病因性脂肪肝的 PR 为 0.68（0.66 至 0.71），MAFLD-单一病因性脂肪肝的 PR 为 0.83（0.83 至 0.84）（异质性 P 值<0.001）。在整体健康生活方式评分中每增加 1 分。在中位随访 4.4 年后，MAFLD 的 RR（95%CI）为 0.83（0.81 至 0.85），MAFLD-O 的 RR 为 0.83（0.81 至 0.85），MAFLD-L 的 RR 为 0.71（0.62 至 0.81），MAFLD-T2D 的 RR 为 0.68（0.64 至 0.72）（异质性 P 值<0.001）；MAFLD-双重病因的 RR 为 0.83（0.81 至 0.85），MAFLD-单一病因的 RR 为 0.70（0.58 至 0.85）（异质性 P 值=0.08）。在有随访数据的 15721 名参与者的前瞻性分析中，这些发现得到了验证，并且还得到了脂肪肝指数和质子密度脂肪分数数据的支持。
包括 6 个基于证据的因素的整体健康生活方式与较低的 MAFLD 风险密切相关，尤其是与多种病因相关的亚型。
