title: Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  To investigated in non-alcoholic-fatty-liver-disease (NAFLD), with ultrasound (US)-detected fatty liver, and in a group of non-alcoholic and otherwise healthy subjects, relationship of neglected features of lifestyle with NAFLD and obesity.
  
  
  METHODS
  Five hundred and thirty-two NAFLD and 667 non-NAFLD healthy subjects, age 21-60 years were studied. Severity of liver steatosis was assessed by US bright liver score. The adherence to mediterranean diet score (AMDS) was assessed on the basis of a 1-wk recall computerized questionnaire which included a detailed physical activity reports (Baecke questionnaire). The western dietary profile score, as a simplified paradigm of unhealthy diet, a questionnaire quantifying sun exposure score and a sleep habits questionnaires provided a further comprehensive lifestyle assessment.
  
  
  RESULTS
  Body mass index (BMI), insulin resistance (HOMA), and triglycerides, poorer adherence to a mediterranean diet profile, sedentary habits, minor sun exposure and use of "western diet" foods are greater in NAFLD. Multiple linear regression analysis, weighted by years of age, displays BMI, HOMA and AMDS as the most powerful independent predictors of fatty liver severity; however, also the physical activity score, the western diet habit and the sun exposure score are acting inside the model with significant independent effects.
  
  
  CONCLUSIONS
  Articulated clinical intervention, according to our results, are justified in NAFLD and can be pursued addressing by focused intervention nutritional profile, physical exercise mainly in open-air subsets for enhancing sun exposure and healthier sleep duration and rhythm.
authors.affiliation: Francesca M Trovato, Giuseppe Fabio Martines, Daniela Brischetto, Daniela Catalano, Department of Clinical and Experimental Medicine, Postgraduate School of Clinical Echography, the University of Catania, 95100 Catania, Italy.
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Trovato
authors.affiliation: Francesca M Trovato, Giuseppe Fabio Martines, Daniela Brischetto, Daniela Catalano, Department of Clinical and Experimental Medicine, Postgraduate School of Clinical Echography, the University of Catania, 95100 Catania, Italy.
authors.forename: Giuseppe Fabio
authors.initials: GF
authors.lastname: Martines
authors.affiliation: Francesca M Trovato, Giuseppe Fabio Martines, Daniela Brischetto, Daniela Catalano, Department of Clinical and Experimental Medicine, Postgraduate School of Clinical Echography, the University of Catania, 95100 Catania, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Brischetto
authors.affiliation: Francesca M Trovato, Giuseppe Fabio Martines, Daniela Brischetto, Daniela Catalano, Department of Clinical and Experimental Medicine, Postgraduate School of Clinical Echography, the University of Catania, 95100 Catania, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Trovato
authors.affiliation: Francesca M Trovato, Giuseppe Fabio Martines, Daniela Brischetto, Daniela Catalano, Department of Clinical and Experimental Medicine, Postgraduate School of Clinical Echography, the University of Catania, 95100 Catania, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Catalano
keywords: Clinical risk management; Diet; Fatty liver; Health psychology; Malnutrition; Obesity; Sleep; Sun exposure; Ultrasound