Vigorous physical activity provides protection against all‐cause deaths among adults patients with nonalcoholic fatty liver disease (NAFLD)

Abstract

Summary Background Mortality benefits of vigorous leisure time physical activity (LTPA) among adults with NAFLD is not known. Aim To investigate association between LTPA and reduction in all‐cause mortality among adults with NAFLD. Methods We used NHANES (1999–2006) self‐reported PA data for adults (≥40 years) with mortality follow‐up through December 31, 2015. US‐Fatty Liver Index in absence of secondary causes identified NAFLD. Moderate and vigorous LTPA were calculated by the 2018 PA Guidelines for Americans. Results NAFLD prevalence among 5211 adults (46.2% male; 75.8% white; mean age 53.2 years) was 32.7%. Adults with NAFLD were less likely to report the recommended minimal PA (≥ 150 min/week, 55.5% vs 64.8%) or highly active PA (≥300 min/week, 39.2% vs 48.5%) compared to adults without NAFLD. Over a median follow‐up of 12.3 years, 355 deaths among adults with NAFLD and 510 deaths among adults without NAFLD were registered. In the metabolic comorbidities‐adjusted model, adults with NAFLD who reported ≥50% of their total PA as vigorous activity had a 56% reduction in all‐cause mortality risk (HR:0.44, 95%CI: 0.25–0.76) and cancer‐specific mortality risk (HR: 0.21, 0.06–0.66) but not cardiac‐specific mortality (p > 0.05) compared to adults with NAFLD who did not report any LTPA. This association remained significant even among adults with NAFLD who met the recommended minimal PA, among adults with NAFLD who reported any LTPA, and among adults with NAFLD who had metabolic abnormalities and in sensitivity analysis. Conclusions Engaging in vigorous activity is beneficial for adults with NAFLD ‐ especially those with metabolic abnormalities.

Editorial: let's get physical—long‐term benefits of vigorous physical activity in patients with nonalcoholic fatty liver disease. Authors' reply

“…In addition, this benefit was achieved when NAFLD subjects achieved at least 150 min of exercise but no more than 299 min of physical activity and at least 50% of their time was spent participating in vigorous activity. 2 The recommendation that 2 minutes of moderate activity can count as 1 minute of vigorous activity was not observed in our study. 5 Nevertheless, we recommend further exploration and research in this area.…”

“…However, notably our results indicated that vigorous activity, not moderate activity, was associated with a mortality benefit. In addition, this benefit was achieved when NAFLD subjects achieved at least 150 min of exercise but no more than 299 min of physical activity and at least 50% of their time was spent participating in vigorous activity 2 . The recommendation that 2 minutes of moderate activity can count as 1 minute of vigorous activity was not observed in our study 5 .…”

“…We thank Heinle et al for their thoughtful comments 1 about our recent article, "Vigorous physical activity provides protection against all-cause mortality among adults with nonalcoholic fatty liver disease (NAFLD)". 2 We agree that attention needs to be directed towards continual identification of the intensity and dose of physical activity that is needed to benefit adults with NAFLD. This is especially important as we emerge from the COVID-19 pandemic where 50% of adults reportedly gained weight which may potentially worsen the trajectory of those with NAFLD.…”

“…We thank Heinle et al for their thoughtful comments 1 about our recent article, “Vigorous physical activity provides protection against all‐cause mortality among adults with nonalcoholic fatty liver disease (NAFLD)” 2 . We agree that attention needs to be directed towards continual identification of the intensity and dose of physical activity that is needed to benefit adults with NAFLD.…”

Editorial: let's get physical—long‐term benefits of vigorous physical activity in patients with nonalcoholic fatty liver disease

“…In a recent edition of Alimentary Pharmacology & Therapeutics , Henry et al 8 performed a longitudinal analysis of over 5000 adults from the National Health and Nutrition Examination Survey (NHANES) in which they examined the association between leisure‐time PA and mortality in patients with NAFLD, with particular attention to vigorous intensity PA. While vigorous‐intensity PA was reported by ~25% of the study population over the 12+ year follow‐up period, this intensity conferred a 56% lower risk of all‐cause mortality and a 79% reduction in cancer‐related mortality for individuals with NAFLD who spent at least 50% of their total PA engaged in vigorous activity, confirming a recent population‐based report about the association between vigorous PA and hepatocellular carcinoma in ¾ a million patients 9 .…”