High-Quality Diet, Physical Activity Could Help Reduce MASLD and MetALD Risk

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New research is shedding light on the critical role physical activity and diet quality play in reducing the risk of metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and etiology-associated steatohepatitis (MetALD), and compensated advanced chronic liver disease (cACLD).¹

The analysis of National Health and Nutrition Examination Survey (NHANES) 2017–2020 data found a significant inverse relationship between both physical activity and diet quality with the risks of MASLD, MetALD, and cACLD, highlighting the essential role of lifestyle factors in the prevention and management of liver diseases associated with metabolic dysfunction.¹

“Understanding MASLD, MetALD, and cACLD is essential given the increasing prevalence of these conditions, driven largely by global lifestyle trends,” Shuang Wang, of the department of geriatrics at The People's Hospital of Changshou in China, and colleagues wrote.¹ “Although physical activity and diet quality are recognized as important, limited research has explored their combined impact on MASLD, MetALD, and cACLD.”

Estimated to affect more than 100 million US adults, MASLD is often characterized by diabetes, insulin resistance, being overweight or obese, elevated blood lipids such as cholesterol and triglycerides, and high blood pressure.² Given the role metabolic components play in disease development, diet and exercise have been hypothesized to be associated with steatotic liver disease (SLD) risk.

To investigate the associations of physical activity and diet quality with the risks of MASLD, MetALD, and cACLD, investigators conducted a cross-sectional study examining data for individuals ≥ 18 years of age with available data on ultrasonographic determination of hepatic steatosis in the NHANES 2017–2020 cycle.¹

Investigators assessed diet quality using the Healthy Eating Index-2015 (HEI-2015). This was calculated using total nutrient intake data from the first NHANES 24-hour dietary recall for each participant to compute the individual components of the HEI-2015, which were then aggregated into an overall diet quality score.¹

Physical activity was assessed based on self-reported activity intensity, frequency, and duration over the past 7 days. Based on their total physical activity volume, investigators categorized participants into 3 groups: low active (physical activity volume < 150 min per week); moderate active (≥150 min but <300 min per week); and high active (≥300 min per week).¹

Investigators defined SLD as the presence of evidence of liver steatosis from ultrasound findings, including a controlled attenuation parameter (CAP) threshold of 285 dB/m. They then classified participants into different SLD subcategories:

• MASLD was defined based on the absence of viral hepatitis or significant alcohol consumption
• MetALD was defined as patients with MASLD who consumed >140–350 g (women) and >210–420 g (men) of alcohol per week or who had drug-induced or monogenic disease-related steatosis
• cACLD was defined as a liver stiffness measurement ≥10 kPa

Among a cohort of 7125 NHANES participants, the prevalence of MASLD and MetALD was 35.07 and 21.46%, respectively. Investigators noted individuals without SLD were more likely to engage in high levels of physical activity (78.54%) compared to those with MASLD (68.16%) or MetALD (72.75%). Similarly, the proportion of participants without SLD who adhered to a high-quality diet (36.37%) was significantly greater than in the MASLD (30.08%) and MetALD (23.65%) groups.¹

Upon analysis, a high-quality diet was associated with significantly lower risks of MASLD (odds ratio [OR], 0.49; 95% CI, 0.38–0.62) and MetALD (OR, 0.45; 95% CI, 0.36–0.56). Similarly, high physical activity levels were also linked to reduced risks of MASLD (OR, 0.47; 95% CI, 0.38–0.58) and MetALD (OR, 0.53; 95% CI, 0.39–0.72). The same was true for cACLD risk, which was reduced with a high-quality diet (OR, 0.47; 95% CI, 0.31–0.72) and increased physical activity (OR, 0.45; 95% CI, 0.32–0.63).¹

Compared with participants with lower levels of physical activity and lower diet quality, high-activity participants with a high-quality diet exhibited the lowest risk of MASLD (OR, 0.41; 95% CI, 0.32–0.53). Compared with that in MASLD, the decreased risk of high-activity participants with a high-quality diet was greater in MetALD (OR, 0.54; 95% CI, 0.41–0.71). Similarly, highly active participants with a high-quality diet had a lower risk of cACLD (OR, 0.44; 95% CI, 0.24–0.82).¹

“These results support the importance of lifestyle interventions in liver health and highlight the need for public health strategies and clinical approaches that promote physical activity and improve diet quality to prevent and manage liver diseases,” investigators concluded.¹ “Further research is necessary to better understand the underlying mechanisms and confirm the causality of these relationships through longitudinal studies.”

References

1. ^{Wang P, Xia B, Wang S. Diet quality and physical activity affect metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction and etiology-associated steatohepatitis, and compensated advanced chronic liver disease among United States adults: NHANES 2017-2020. Front Nutr. doi:10.3389/fnut.2024.1505970.}
2. ^{American College of Gastroenterology. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Accessed January 24, 2025. https://gi.org/topics/steatotic-liver-disease-masld/}