Abstract
Background & Aims
The goal of this study was to examine the association of sitting time and physical
activity level with non-alcoholic fatty liver disease (NAFLD) in Korean men and women
and to explore whether any observed associations were mediated by adiposity.
Methods
A cross-sectional study was performed on 139,056 Koreans, who underwent a health examination
between March 2011 and December 2013. Physical activity level and sitting time were
assessed using the validated Korean version of the international Physical Activity
Questionnaire Short Form. The presence of fatty liver was determined using ultrasonographic
findings. Poisson regression models with robust variance were used to evaluate the
association of sitting time and physical activity level with NAFLD.
Results
Of the 139,056 subjects, 39,257 had NAFLD. In a multivariable-adjusted model, both
prolonged sitting time and decreased physical activity level were independently associated
with increasing prevalence of NAFLD. The prevalence ratios (95% CIs) for NAFLD comparing
5–9 and ⩾10 h/day sitting time to <5 h/day were 1.04 (1.02–1.07) and 1.09 (1.06–1.11), respectively (p for trend <0.001). These associations were still observed in subjects with BMI <23 kg/m2. The prevalence ratios (95% CIs) for NAFLD comparing minimally active and health-enhancing
physically active groups to the inactive group were 0.94 (0.92–0.95) and 0.80 (0.78–0.82),
respectively (p for trend <0.001).
Conclusions
Prolonged sitting time and decreased physical activity level were positively associated
with the prevalence of NAFLD in a large sample of middle-aged Koreans, supporting
the importance of reducing time spent sitting in addition to promoting physical activity.
Graphical abstract
Graphical Abstract
Abbreviations:
BMI (body mass index), CI (confidence interval), CVD (cardiovascular disease), FLI (fatty liver index), HEPA (health-enhancing physically active), HOMA-IR (homeostasis model assessment of insulin resistance), HDL-C (high-density lipoprotein-cholesterol), LDL-C (low-density lipoprotein-cholesterol), NAFLD (non-alcoholic fatty liver disease), SMI (skeletal muscle mass)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of HepatologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Physical activity and television watching in relation to risk of type 2 diabetes, the Black Women’s Health Study.Am J Epidemiol. 2009; 169: 428-434
- Dose response between physical activity and risk of coronary heart disease, a meta-analysis.Circulation. 2011; 124: 789-795
- Walking compared with vigorous exercise for the prevention of cardiovascular events in women.N Engl J Med. 2002; 347: 716-725
- Amount of time spent in sedentary behaviors in the United States, 2003–2004.Am J Epidemiol. 2008; 167: 875-881
- Associations of TV viewing and physical activity with the metabolic syndrome in Australian adults.Diabetologia. 2005; 48: 2254-2261
- Physical activity and television watching in relation to risk for type 2 diabetes mellitus in men.Arch Intern Med. 2001; 161: 1542-1548
- Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease.Diabetes. 2007; 56: 2655-2667
- Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults, a systematic review and meta-analysis.Ann Intern Med. 2015; 162: 123-132
- Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study.Cancer Causes Control. 2008; 19: 939-953
- Too much sitting, the population health science of sedentary behavior.Exerc Sport Sci Rev. 2010; 38: 105-113
- Amount of time spent in sedentary behaviors and cause-specific mortality in US adults.Am J Clin Nutr. 2012; 95: 437-445
- The histological course of nonalcoholic fatty liver disease, a longitudinal study of 103 patients with sequential liver biopsies.J Hepatol. 2005; 42: 132-138
- The spectrum expanded, cryptogenic cirrhosis and the natural history of non-alcoholic fatty liver disease.J Hepatol. 2004; 40: 578-584
- The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis.Hepatology. 2010; 51: 1972-1978
- NAFLD as a risk factor for the development of diabetes and the metabolic syndrome, an eleven-year follow-up study.Am J Gastroenterol. 2009; 104: 861-867
- Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular disease in patients with type 1 diabetes.J Hepatol. 2010; 53: 713-718
- Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up.J Hepatol. 2012; 56: 1145-1151
- Cellular mechanism of insulin resistance in nonalcoholic fatty liver disease.Proc Natl Acad Sci U S A. 2011; 108: 16381-16385
- Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity, a molecular reason to maintain daily low-intensity activity.J Physiol. 2003; 551: 673-682
- Physical inactivity amplifies the sensitivity of skeletal muscle to the lipid-induced downregulation of lipoprotein lipase activity.J Appl Physiol. 2006; 100: 249-257
- Skeletal muscle-specific deletion of lipoprotein lipase enhances insulin signaling in skeletal muscle but causes insulin resistance in liver and other tissues.Diabetes. 2009; 58: 116-124
- The epidemiology of nonalcoholic fatty liver disease, a global perspective.Semin Liver Dis. 2008; 28: 339-350
- Labor saved, calories lost, the energetic impact of domestic labor-saving devices.Obes Res. 2003; 11: 1178-1181
- Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity.PLoS One. 2011; 6: e19657
- Non-alcoholic fatty liver disease is associated with higher levels of measured sedentary behaviour and lower levels of physical activity than matched healthy controls.Frontline Gastroenterol. 2015; 6: 44-51
- Metabolically-healthy obesity and coronary artery calcification.J Am Coll Cardiol. 2014; 63: 2679-2686
- Age at menarche and non-alcoholic fatty liver disease.J Hepatol. 2015; 62: 1164-1170
- The diagnosis and management of non-alcoholic fatty liver disease, practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association.Hepatology. 2012; 55: 2005-2023
- International physical activity questionnaire, 12-country reliability and validity.Med Sci Sports Exerc. 2003; 35: 1381-1395
- Validity and reliability of Korean version of International Physical Activity Questionnaire (IPAQ) short form.Korean J Fam Med. 2007; 28: 532-541
- Recent temporal trends in sleep duration, domain-specific sedentary behaviour and physical activity. A survey among 25–79-year-old Danish adults.Scand J Public Health. 2013; 41: 706-711
- Validation and reproducibility of food frequency questionnaire for Korean genome epidemiologic study.Eur J Clin Nutr. 2007; 61: 1435-1441
- Computer aided nutritional analysis program for professionals 4.0.The Korean Nutrition Society, Seoul2010
- The Pittsburgh Sleep Quality Index, a new instrument for psychiatric practice and research.Psychiatry Res. 1989; 28: 193-213
- Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians.Public Health Nutr. 2009; 12: 497-506
- Cross-calibration of eight-polar bioelectrical impedance analysis versus dual-energy X-ray absorptiometry for the assessment of total and appendicular body composition in healthy subjects aged 21–82 years.Ann Hum Biol. 2003; 30: 380-391
- Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases.Dig Liver Dis. 2002; 34: 516-522
- Sleep duration and quality in relation to non-alcoholic fatty liver disease in middle-aged workers and their spouses.J Hepatol. 2013; 59: 351-357
- The Fatty Liver Index, a simple and accurate predictor of hepatic steatosis in the general population.BMC Gastroenterol. 2006; 6: 33
Canadian Society for Exercise Physiology. Canadian physiology activity guidelines and canadian sedentary behavior guidelines, 2013. Accessed at <www.csep.ca/guidelines>.
- Evidence-informed physical activity guidelines for Canadian adults.Can J Public Health. 2007; 98: S16-S68
- Relative intensity of physical activity and risk of coronary heart disease.Circulation. 2003; 107: 1110-1116
- Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity, a population-based study.Aliment Pharmacol Ther. 2012; 36: 772-781
- Role of physical activity in nonalcoholic fatty liver disease in terms of visceral obesity and insulin resistance.Liver Int. 2015; 35: 944-952
- Effects of substituting sedentary time with physical activity on metabolic risk.Med Sci Sports Exerc. 2014; 46: 1946-1950
- Breaking up prolonged sitting reduces postprandial glucose and insulin responses.Diabetes Care. 2012; 35: 976-983
- Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable.PLoS One. 2013; 8: e55542
- Sarcopaenia is associated with NAFLD independently of obesity and insulin resistance, Nationwide surveys (KNHANES 2008–2011).J Hepatol. 2015; 63: 486-493
- Ability of fat and fat-free mass percentages to predict functional disability in older men and women.J Am Geriatr Soc. 2001; 49: 1641-1645
- Grading body fatness from limited anthropometric data.Am J Clin Nutr. 1981; 34: 2831-2838
- Relationships between the Body Mass Index and body composition.Obes Res. 1996; 4: 35-44
- Beyond the body mass index, tracking body composition in the pathogenesis of obesity and the metabolic syndrome.Obes Rev. 2012; 13: 6-13
- Weight gain within the normal weight range predicts ultrasonographically detected fatty liver in healthy Korean men.Gut. 2009; 58: 1419-1425
- Influence of exercise on insulin sensitivity.J Cardiovasc Risk. 1995; 2: 303-309
- Nonalcoholic fatty liver disease and the metabolic syndrome.Curr Opin Lipidol. 2005; 16: 421-427
- Metabolic syndrome and non-alcoholic fatty liver disease, Asian definitions and Asian studies.Hepatobiliary Pancreat Dis Int. 2007; 6: 572-578
- Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults, a systematic review.J Hepatol. 2012; 56: 255-266
- Exercise and non-alcoholic fatty liver disease, a systematic review and meta-analysis.J Hepatol. 2012; 57: 157-166
- Diagnosis of fatty liver disease, is biopsy necessary?.Eur J Gastroenterol Hepatol. 2003; 15: 539-543
- Defining nonalcoholic fatty liver disease, implications for epidemiologic studies.Gastroenterology. 2003; 124: 248-250
- The spectrum of liver disease in the general population, lesson from the Dionysos study.J Hepatol. 2001; 35: 531-537
- Assessment of physical activity in older adults.Res Q Exerc Sport. 2000; 71: S79-S88
- The descriptive epidemiology of sitting. A 20-country comparison using the International Physical Activity Questionnaire (IPAQ).Am J Prev Med. 2011; 41: 228-235
Article Info
Publication History
Published online: September 14, 2015
Accepted:
July 9,
2015
Received in revised form:
July 2,
2015
Received:
May 14,
2015
See Editorial, pages 1064–1065Identification
Copyright
© 2015 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
