Jialu Wang1,2, Yan Qi1,2, Zhuojun Xin1,2, Yanan Huo3, Qin Wan4, Yingfen Qin5, Ruying Hu6, Lixin Shi7, Qing Su8, Xuefeng Yu9, Li Yan10, Guijun Qin11, Xulei Tang12, Gang Chen13, Min Xu1,2, Yu Xu1,2, Tiange Wang1,2, Zhiyun Zhao1,2, Zhengnan Gao14, Guixia Wang15, Feixia Shen16, Zuojie Luo5, Li Chen17, Qiang Li18, Zhen Ye6, Yinfei Zhang19, Chao Liu20, Youmin Wang21, Tao Yang22, Huacong Deng23, Lulu Chen24, Tianshu Zeng24, Jiajun Zhao25, Yiming Mu26, Shengli Wu27, Yuhong Chen1,2, Jieli Lu1,2, Weiqing Wang1,2, Guang Ning1,2, Yufang Bi1,2, Mian Li1,2. 1. Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. 2. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. 3. Jiangxi Provincial People's Hospital, Affiliated to Nanchang University, Nanchang, Xinjiang, China. 4. Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, China. 5. Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China. 6. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. 7. Department of Endocrinology, Affiliated Hospital of Guiyang Medical University, Guiyang, China. 8. Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. 9. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 10. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. 11. Department of Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. 12. Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, China. 13. Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China. 14. Dalian Municipal Central Hospital, Affiliated of Dalian Medical University, Dalian, China. 15. Department of Endocrinology, The First Hospital of Jilin University, Changchun, China. 16. Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. 17. Qilu Hospital of Shandong University, Jinan, China. 18. Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China. 19. Department of Endocrinology, Central Hospital of Shanghai Jiading District, Shanghai, China. 20. Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China. 21. Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, China. 22. Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 23. Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 24. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 25. Shandong Provincial Hospital, Affiliated to Shandong University, Jinan, China. 26. Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing, China. 27. Department of Endocrinology, Karamay Municipal People's Hospital, Xinjiang, China.
Abstract
BACKGROUND: Lack of physical activity and excessive sitting time contributed to ectopic fat accumulation, especially in the liver. Previous studies have illustrated the harm of sedentary behaviour and the benefits of physical activity on fatty liver disease. We aimed to explore the association between the behaviour patterns and the risk of metabolic dysfunction-associated fatty liver disease (MAFLD) using isotemporal substitution model to examine the effect of replacing one behaviour to another while keeping the total time and other behaviours fixed among Chinese middle-aged and elderly population. METHODS: This study included 161 147 participants aged ≥40 years old from the nationwide, population-based cohort of the REACTION study. The International Physical Activity Questionnaire was used to measure self-reported time for sleeping, sitting, walking and moderate-to-vigorous physical activity (MVPA). MAFLD was defined by evidence of fatty liver index (FLI) ≥ 60 in addition to one of the following three patterns, namely overweight/obesity, presence of diabetes, or evidence of metabolic dysregulation. Isotemporal substitution models using logistic regression models to evaluate the association of replacement of different behaviour patterns with each other and the risk of MAFLD. RESULTS: Substitution of 60 minutes per day of sleeping, walking or total MVPA for sitting was associated with a 2%-8% reduction of MAFLD risk in overall participants. In employed individuals, replacing sitting time with occupational MVPA or nonoccupational MVPA both could bring benefits to liver steatosis. Stratified analysis found that replacing 60 minutes of sitting time with an equivalent time of other behaviour pattern could reduce approximately 8% of the risk among MAFLD participants with metabolic abnormalities. Such a relationship might be explained by the important mediated role of metabolic elements, such as waist circumference, body mass index, triglycerides and homoeostasis model assessment of insulin resistance. Furthermore, replacing sitting with MVPA showed a stronger association among participants who got enough sleep (sleep duration ≥7 hours per day). CONCLUSION: Replacing sitting with other behaviour patterns could reduce the prevalence of MAFLD, and such substitution effect was much remarkably in individuals with abnormal metabolic status. Observably, obese individuals were more likely to benefit from appropriate changes in behaviour patterns. Moreover, the analysis of sleep duration stratification appealed that the adequacy of individual sleep duration also had a significant impact on the substitution effect. It is worth noting that adjusting the time allocation of behaviour patterns might have a beneficial impact on liver-metabolic health, and these findings might help us better recognize the importance of reasonable arrangement of behaviour patterns according to the individual's situation.
BACKGROUND: Lack of physical activity and excessive sitting time contributed to ectopic fat accumulation, especially in the liver. Previous studies have illustrated the harm of sedentary behaviour and the benefits of physical activity on fatty liver disease. We aimed to explore the association between the behaviour patterns and the risk of metabolic dysfunction-associated fatty liver disease (MAFLD) using isotemporal substitution model to examine the effect of replacing one behaviour to another while keeping the total time and other behaviours fixed among Chinese middle-aged and elderly population. METHODS: This study included 161 147 participants aged ≥40 years old from the nationwide, population-based cohort of the REACTION study. The International Physical Activity Questionnaire was used to measure self-reported time for sleeping, sitting, walking and moderate-to-vigorous physical activity (MVPA). MAFLD was defined by evidence of fatty liver index (FLI) ≥ 60 in addition to one of the following three patterns, namely overweight/obesity, presence of diabetes, or evidence of metabolic dysregulation. Isotemporal substitution models using logistic regression models to evaluate the association of replacement of different behaviour patterns with each other and the risk of MAFLD. RESULTS: Substitution of 60 minutes per day of sleeping, walking or total MVPA for sitting was associated with a 2%-8% reduction of MAFLD risk in overall participants. In employed individuals, replacing sitting time with occupational MVPA or nonoccupational MVPA both could bring benefits to liver steatosis. Stratified analysis found that replacing 60 minutes of sitting time with an equivalent time of other behaviour pattern could reduce approximately 8% of the risk among MAFLD participants with metabolic abnormalities. Such a relationship might be explained by the important mediated role of metabolic elements, such as waist circumference, body mass index, triglycerides and homoeostasis model assessment of insulin resistance. Furthermore, replacing sitting with MVPA showed a stronger association among participants who got enough sleep (sleep duration ≥7 hours per day). CONCLUSION: Replacing sitting with other behaviour patterns could reduce the prevalence of MAFLD, and such substitution effect was much remarkably in individuals with abnormal metabolic status. Observably, obese individuals were more likely to benefit from appropriate changes in behaviour patterns. Moreover, the analysis of sleep duration stratification appealed that the adequacy of individual sleep duration also had a significant impact on the substitution effect. It is worth noting that adjusting the time allocation of behaviour patterns might have a beneficial impact on liver-metabolic health, and these findings might help us better recognize the importance of reasonable arrangement of behaviour patterns according to the individual's situation.