High-quality diet, physical activity, and college education are associated with low risk of NAFLD among the US population
Abstract
BACKGROUND AND AIMS: The effects of diet quality (DQ), physical activity (PA), and socioeconomic status (SES) on the risk of NAFLD are unclear. We examined the association among DQ, PA, SES, and NAFLD risk. APPROACH AND RESULTS: This is a cross-sectional analysis of the National Health and Nutrition Examination Surveys, 2017-2018, which included 3589 participants with reliable information on vibration-controlled transient elastography (VCTE) measurements, 24-h dietary recalls, PA, and SES. DQ was assessed by the Healthy Eating Index (HEI)-2015. PA was determined by the Global Physical Activity Questionnaire. SES was assessed by the educational attainment and family poverty income ratio (PIR). Risk of NAFLD was considered by means of a composite outcome using VCTE measurements: non-NAFLD versus NAFLD without clinically significant fibrosis (CSF) versus NAFLD with CSF. The NAFLD risk was lower in physically active (≥600 metabolic equivalent of task [MET] min/week) versus inactive participants (<600 MET min/week) (OR: 0.71, p = 0.043). A high-quality diet (HQD) (HEI > 56.64) was associated with a lower risk of NAFLD (OR: 0.58, p < 0.01) compared with a non-HQD. The lowest NAFLD risk was observed in those physically active with HQD (OR: 0.43, p < 0.01). Body mass index and waist circumference significantly mediated the effect of DQ and PA on NAFLD risk. Education (college or above) (OR: 0.65, p = 0.034), but not PIR, was associated with a reduced NAFLD risk. HQD and increased PA partially mediated the effect of education on NAFLD risk. The total effect of education on NAFLD risk mediated by DQ was 29% and by PA was 8%. CONCLUSIONS: HQD, increased physical activity, and college education were associated with lower NAFLD risk in the US population.
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MASLD is impacted by socioeconomic inequities, which are related to greater obesity prevalence, lower nutritional quality and lower physical activity.
“Furthermore, MASLD is impacted by socioeconomic inequities, which are related to greater obesity prevalence, lower nutritional quality and lower physical activity. 37 -39”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [37]
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- Authors
- Vilar‐Gomez, E., Nephew, L. D., Vuppalanchi, R., Gawrieh, S., Mladenovic, A., Pike, F., Samala, N., & Chalasani, N.
- Affiliations
- Department of Medicine,Indiana University School of Medicine,Indianapolis,Indiana,USA
- Indiana University Indianapolis (US)
- Indiana University School of Medicine (US)
- Corresponding author
- Chalasani, Naga
- ORCID
- Venue
- Hepatology
- Published
- 2021-12-14
- Volume
- 75
- Issue
- 6
- Pages
- 1491-1506
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W3206169013
- Cited by
- 277
- References
- 34
- Citations by year
- 2026: 30 · 2025: 65 · 2024: 96 · 2023: 60 · 2022: 24 · 2021: 2
- FWCI
- 32.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Purdue University Indianapolis (Indiana University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
- Keywords
- non-alcoholic fatty liver disease, diet quality, physical activity, university education, socioeconomic status, Healthy Eating Index, vibration-controlled transient elastography, mediation analysis, body mass index, waist circumference, poverty income ratio
- MeSH terms
- Cross-Sectional Studies, Diet, Fibrosis, Humans, Nutrition Surveys, Exercise, Non-alcoholic Fatty Liver Disease
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