title: Relation of physical activity to prevalence of nonalcoholic Fatty liver disease independent of cardiometabolic risk.
abstract: Nonalcoholic fatty liver disease (NAFLD) is associated with obesity and insulin resistance and has been linked with increased cardiovascular risk. Although physical activity (PA) and lifestyle modification are often recommended in patients at cardiovascular risk, the benefit across the cardiometabolic risk spectrum is unclear. We aimed to evaluate the relation of PA and NAFLD independent of metabolic syndrome (MS) or obesity. We evaluated 5,743 healthy Brazilian subjects (43 ± 10 years, 79% men) without clinical coronary heart disease from December 2008 to December 2010. NAFLD was diagnosed using ultrasounds, and self-reported PA was assessed using the International Physical Activity Questionnaire scale. In a multivariate logistic regression adjusted for cardiometabolic risk factors, we evaluated for an independent association of NAFLD and PA. In the total study population, NAFLD prevalence was 36% (n = 2,075), obesity 23% (1,300), and MS 20% (1,152). NAFLD was more prevalent in subjects with MS (74%) than those without (26%) and in those obese (73%) than in those nonobese (25%). Overall, 1,305 (23%) subjects reported low activity, 1,990 (35%) moderate activity, and 2,448 (42%) high activity. NAFLD prevalence was lower at higher levels of reported PA (low 45%, moderate 38%, and high 30%, p <0.001). After adjusting for risk factors, subjects with high activity had lower odds of having NAFLD. The favorable association was independent of obesity or MS. In conclusion, PA presents a dose-response association with NAFLD independent of the MS or obesity. Our results are compatible with the idea that benefits of PA are relevant to everyone regardless of cardiometabolic risk.
authors.affiliation: Department of Medicine, The Brooklyn Hospital Center, Affiliate of Icahn School of Medicine at Mount Sinai, Brooklyn, New York; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida. Electronic address: Ebo9003@nyp.org.
authors.forename: Ebenezer T
authors.initials: ET
authors.lastname: Oni
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Rohan
authors.initials: R
authors.lastname: Kalathiya
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida.
authors.forename: Ehimen C
authors.initials: EC
authors.lastname: Aneni
authors.affiliation: Department of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
authors.affiliation: Department of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida.
authors.forename: Theodore
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Agatston
authors.affiliation: Department of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors.forename: Raquel D
authors.initials: RD
authors.lastname: Conceiçao
authors.affiliation: Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors.forename: Jose A M
authors.initials: JA
authors.lastname: Carvalho
authors.affiliation: Preventive Medicine Center, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Lipid Clinic-Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; Department of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors