For people with steatotic liver disease, even modest levels of physical activity can reduce – by 16% – the risk for all-cause mortality, against those who were inactive, regardless of fibrosis status, reports Healio.
Data presented at this week’s American College of Gastroenterology Annual Scientific Meeting in Tennessee, showed that the greatest reduction in mortality was observed when individuals moved from a sedentary lifestyle to relatively modest levels of physical activity.
“It is already established that cardiovascular disease remains a major cause of death in these patients, and we do see poor cardiovascular status,” Sahiljot Singh Bhupal, MD, MSHIST, a second-year internal medicine resident at St Francis Medical Centre in California told Healio.
“We already know that exercise is one of the foundations of treatment. It can improve hepatic steatosis and cardiometabolic health even without significant weight loss.
“But we felt there were still some important unanswered questions about why physical activity is associated with better long-term outcomes,” he added.
Bhupal and colleagues analysed data from the 1988-1994 National Health and Nutrition Examination Survey and National Death Index up to 2019 to evaluate the dose-response relationship between physical activity and all-cause mortality among people with steatotic liver disease.
The researchers classified participants as “physically active” if they reported any leisure-time activity (> 0 MET-minutes per week) and “inactive” if they reported none (0 MET-minutes), using self-reported data from NHANES interviews. They also estimated liver fibrosis via FIB-4 index values and stratified participants as low, intermediate or high risk.
Final analysis included 4 441 adults aged 20 to 74, representing 46.3m adults. Most (85.5%) had metabolic dysfunction-associated liver disease, 12.2% had metabolic dysfunction and alcohol-associated liver disease, and 2.3% had alcohol-associated liver disease.
Over median follow-up of 26 years, 1 903 deaths occurred. Mortality was significantly lower among individuals who were physically active vs inactive (36.4% vs 44%; P = .008).
Those who were physically active were more likely to be men (55% vs 34.9%), had attained at least a college education (19.8% vs 6.4%) and had a higher income-to-poverty ratio (3.27 vs 2.35).
The link between physical activity and lower all-cause mortality was significant only for MASLD.
Analysis adjusted for demographic, socioeconomic and clinical factors showed physical activity was associated with a 16% lower risk for all-cause mortality (adjusted HR = 0.84; 95% CI, 0.71-0.99). This risk remained the same after including FIB-4 values.
“The hazard ratio essentially did not change,” Bhupal told Healio. “Although fibrosis itself itself remained an important predictor of mortality, it did not appear to explain most of the survival benefit associated with physical activity. That suggests much of the benefit may be coming through extrahepatic pathways, particularly cardiometabolic health.”
The researchers also found that the protective association between physical activity and mortality appeared strongest during the first 10 years of follow-up (aHR = 0.68; 95% CI, 0.49-0.94). However, physical activity was measured only at baseline, Bhupal noted.
“Over 20 or 30 years, people’s activity levels can change substantially,” he said. “The further we get from that original measurement, the less accurately it represents what that person is actually doing. Clinically, I think that reinforces the idea that physical activity is something we need to reassess and encourage over time, rather than discuss once.”
Dose-response analysis also showed a significant nonlinear relationship, with the greatest reduction in mortality occurring when individuals went from being completely inactive to incorporating even modest physical activity.
“We should be talking about physical activity with essentially every patient with steatotic liver disease, and especially with patients who are completely sedentary,” Bhupal said. “We should still encourage patients to work toward guideline-recommended levels of activity, but if somebody is doing no physical activity at all, getting them to start walking or doing another activity they can realistically maintain may already be an important step.”
Bhupal emphasised that these results highlight the importance of holistic care for patients with steatotic liver disease, rather than solely focusing on progression of liver disease.
“Physical activity matters in steatotic liver disease, and its benefits appear to go well beyond the liver,” he said.
No abstract available
See more from MedicalBrief archives:
MASLD cases on the increase – Lancet British study
MASLD to affect almost 2bn people by 2050 – Lancet
One diet drink daily may raise risk of liver disease – Chinese study