People who follow at least three healthy lifestyle habits, including a healthy diet, sufficient physical activity, not smoking and adequate sleep, are 28.6 percent less likely to have metabolic dysfunction-associated steatotic liver disease (MASLD) than those who follow few or none of these habits, a study showed.
The Korea Disease Control and Prevention Agency’s National Institute of Health (NIH) released an analysis using Korea National Health and Nutrition Examination Survey (KNHANES) data to examine the link between healthy lifestyle habits and MASLD.
MASLD is a chronic liver disease characterized by the accumulation of fat in the liver accompanied by cardiometabolic risk factors such as obesity and diabetes.
Previously known as non-alcoholic fatty liver disease, the condition requires ongoing management because it can progress to cirrhosis and is also linked to cardiovascular disease.
The research team analyzed 23,111 adults aged 19 to 80 who participated in KNHANES between 2016 and 2021, excluding those with cirrhosis, hepatitis B or C, excessive alcohol consumption or missing key data.
MASLD was defined as a Hepatic Steatosis Index (HSI) score of 36 or higher combined with at least one of five cardiometabolic risk factors.
The five risk factors were overweight or abdominal obesity; elevated fasting glucose or diabetes; elevated blood pressure or use of antihypertensive medication; elevated triglycerides or use of lipid-lowering medication; and low HDL cholesterol or use of lipid-lowering medication.
Of the 23,111 participants, 5,425 had MASLD, with a weighted prevalence of 24.1 percent, equivalent to roughly one in four Korean adults.
The researchers also examined the association between MASLD and four healthy lifestyle habits: a healthy diet, sufficient physical activity, not smoking and adequate sleep.
A healthy diet was defined as scoring in the top 33.3 percent on the Korean Healthy Eating Index. Sufficient physical activity meant at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week. Non-smoking status was based on survey responses, while adequate sleep meant an average of seven to nine hours per day.
Participants received one point for each healthy lifestyle habit. Those scoring zero or one were classified as having a poor lifestyle, those scoring two as having an intermediate lifestyle, and those scoring three or four as having a healthy lifestyle.
The healthier the lifestyle habits participants followed, the less likely they were to have MASLD. Compared with people who followed zero or one healthy habit, those who followed two were 17.5 percent less likely to have MASLD, while those who followed three or four were 28.6 percent less likely.
Differences were also observed for individual habits. Compared with people who engaged in sufficient physical activity, those with insufficient activity were 24.8 percent more likely to have MASLD. Smokers were 16.5 percent more likely than non-smokers, while those who did not get seven to nine hours of sleep per day were 12.9 percent more likely than those who did.
The association was even stronger when multiple healthy habits were practiced together. People who maintained a healthy diet, engaged in sufficient physical activity and did not smoke were about 32 percent less likely to have MASLD than those who did not follow all three habits, the largest reduction among the combinations analyzed.
“MASLD is closely associated with a range of cardiometabolic risk factors, including obesity, insulin resistance, high blood pressure and lipid abnormalities, making day-to-day lifestyle management important,” said Kim Min-ju, a researcher at the NIH.
“This study is meaningful in that it identified an association between healthy lifestyle habits and MASLD using KNHANES data representative of Korean adults,” Kim added.
The study was published online in the international journal BMC Public Health on June 24.
