The association between physical activity and metabolic dysfunction-associated steatotic liver disease: Evidence from the National Health and Nutrition Examination Survey and UK Biobank.

ObjectiveThere is limited prospective evidence on the association of physical activity with metabolic dysfunction-associated steatotic liver disease. We aimed to use data from two major databases to systematically quantify the correlation of physical activity with the risk of metabolic dysfunction-associated steatotic liver disease.MethodsThis study used data from the National Health and Nutrition Examination Survey (2007-2020) and UK Biobank. Initially, a cross-sectional study was conducted using the data from the National Health and Nutrition Examination Survey data to assess the links between physical activity and metabolic dysfunction-associated steatotic liver disease using weighted logistic regression analysis with appropriate sample weights to ensure national representativeness. Subsequently, Cox proportional hazards regression and restricted cubic splines models were applied to infer causality and evaluate the potential dose-response relationships in the UK Biobank cohort over a median follow-up period of 14.18 years. Additionally, subgroup and sensitivity analyses were conducted to test the robustness of the results.ResultsIn the National Health and Nutrition Examination Survey, higher physical activity levels were inversely associated with metabolic dysfunction-associated steatotic liver disease risk (odds ratio: 0.78, 95% confidence interval: 0.63-0.97). This finding was supported in the UK Biobank cohort (hazard ratio: 0.57, 95% confidence interval: 0.34-0.76). A nonlinear dose-response relationship existed between physical activity and metabolic dysfunction-associated steatotic liver disease (p = 0.023 for a nonlinearity). Subgroup analyses highlighted stronger effects in overweight/obese individuals (hazard ratio: 0.62, 95% confidence interval: 0.43-0.88), suggesting that this high-risk population may derive particular benefit from increased physical activity.ConclusionsAnalyses of two large databases demonstrated a nonlinear dose-response association between higher physical activity levels and reduced metabolic dysfunction-associated steatotic liver disease risk. Moderate physical activity levels (600 to <3000 metabolic equivalent of task-min/week) were significantly protective, and high physical activity levels (≥3000 metabolic equivalent of task-min/week) conferred additional benefits.