High levels of physical activity and cardiorespiratory fitness may protect against non-alcoholic fatty liver disease. We investigated whether different physical activity intensities, and cardiorespiratory fitness, were independent predictors of non-alcoholic fatty liver disease.
We included healthy adults with no prior diagnosis of liver dysfunction. Non-alcoholic fatty liver disease prevalence was estimated based on fatty liver index scores. We created tertiles of self-reported low, moderate, and vigorous physical activity. Participants completed an incremental treadmill test to estimate cardiorespiratory fitness, and data were subsequently separated into quintile groups (Q1 [least fit] through Q5 [most fit]).
Non-alcoholic fatty liver disease prevalence in our sample of 7,111 adults was 28.3% in males, and 6.5% in females. Logistic regression showed the relative odds of non-alcoholic fatty liver disease were 42% lower if >60 min per week of vigorous physical activity was maintained (OR=0.58 CI: 0.49-0.68). There was a negative dose-response association between cardiorespiratory fitness and non-alcoholic fatty liver disease between Q1-Q4. Compared with Q1, odds were 39% (OR=0.61, CI: 0.51-0.73) lower in Q2, through to 51% lower in Q5 (OR=0.49, CI: 0.41-0.60). Moderate physical activity did not reduce the odds of non-alcoholic liver disease.
We found the lowest prevalence of non-alcoholic fatty liver disease in adults achieving >60 min per week of vigorous physical activity. However, a stronger dose-response relationship existed between cardiorespiratory fitness and non-alcoholic fatty liver disease. Improving cardiorespiratory fitness as a potential therapeutic target for treatment and prevention of non-alcoholic fatty liver disease warrants further investigation.

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