Gastroenterology

Gastroenterology

Volume 130, Issue 7, June 2006, Pages 2023-2030
Gastroenterology

Clinical–liver, pancreas, and biliary tract
Association of Cardiorespiratory Fitness, Body Mass Index, and Waist Circumference to Nonalcoholic Fatty Liver Disease

https://doi.org/10.1053/j.gastro.2006.03.019Get rights and content

Background & Aims: There is a need for more work examining the potential of physical activity and/or weight control as a preventive and/or therapeutic option in the treatment of fatty liver diseases. The purpose of this study was to examine the association between cardiorespiratory fitness, body mass index (BMI), and waist circumference with markers of nonalcoholic fatty liver disease (NAFLD). Methods: Participants consisted of 218 apparently healthy nonsmoking, nonalcoholic men aged 33–73 years. Cardiorespiratory fitness was assessed by a maximal treadmill test. Liver and spleen density were measured using a computed tomography scan. We defined the presence of NAFLD as the following 3 conditions being met: (1) liver to spleen density of 1.0 or less, (2) serum alanine transaminase level greater than 30 U/L, and (3) serum aspartate transaminase/alanine transaminase level less than 1.0. Results: Twenty-four (11%) of the participants met the NAFLD definition. There was an inverse association between fitness categories, and a positive association for BMI categories (and waist circumference categories) with the prevalence of NAFLD (P for trend <.001 for all). Fitness and BMI were independent of each other in their associations with the prevalence of NAFLD. The addition of waist circumference to the regression model attenuated the association with prevalence of NAFLD for both fitness (P value changed from <.0001 to .06) and BMI (P value changed from <.001 to .22). Conclusions: Fitness (inversely) and BMI (directly) were associated with the prevalence of NAFLD. However, these associations were attenuated when abdominal obesity was included in the statistical model.

Section snippets

Patient Data

The Aerobics Center Longitudinal Study is an epidemiologic investigation of patients who received a thorough medical examination at the Cooper Clinic in Dallas, Texas. Data collection for the Aerobics Center Longitudinal Study began in 1970, and to date there are more than 70,000 study participants in the database.16, 17, 18 Most of the participants are non-Hispanic whites, residents of the United States, and are well educated. Participants for this analysis are derived from a previously

Results

Table 1 presents the characteristics of the participants by the absence (n = 194) and presence of NAFLD (n = 24, 11.0%). Similar in age, participants with NAFLD were heavier, had more central adiposity, were less fit, and had worse cardiovascular risk factor profiles compared with participants without NAFLD. For example, almost 92% of individuals with NAFLD had metabolic syndrome compared with 30.9% of individuals without NAFLD (P < .001). There was no difference in alcoholic drinks consumed

Discussion

The primary finding of this cross-sectional study was a lower prevalence of NAFLD across higher levels of cardiorespiratory fitness and a higher prevalence of NAFLD across higher levels of BMI and waist circumference. When examined within the same model we found fitness level (inversely) and BMI category (directly) both to be associated significantly with the prevalence of NAFLD. However, both the fitness–NAFLD and BMI–NAFLD relationships were attenuated when central adiposity, in particular

Conclusion

Fitness (inversely) and BMI (directly) were associated with the prevalence of NAFLD. However, these associations were attenuated when abdominal obesity was included in the statistical model. There is a need for future work examining the role of weight loss and physical activity in the prevention and treatment of NAFLD.

References (44)

  • T. Kavanagh et al.

    Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation

    J Am Coll Cardiol

    (2003)
  • J. Ludwig et al.

    Nonalcoholic steatohepatitisMayo Clinic experiences with a hitherto unnamed disease

    Mayo Clin Proc

    (1980)
  • P. Angulo

    Nonalcoholic fatty liver disease

    N Engl J Med

    (2002)
  • S.K. Te et al.

    Non-alcoholic steatohepatitisreview of a growing medical problem

    Eur J Intern Med

    (2004)
  • D. Festi et al.

    Hepatic steatosis in obese patientsclinical aspects and prognostic significance

    Obes Rev

    (2004)
  • A.S. Yu et al.

    Nonalcoholic fatty liver disease

    Rev Gastroenterol Disord

    (2002)
  • F.H. Luyckx et al.

    Liver abnormalities in severely obese subjectseffect of drastic weight loss after gastroplasty

    Int J Obes Relat Metab Disord

    (1998)
  • S. Bellentani et al.

    Prevalence of and risk factors for hepatic steatosis in Northern Italy

    Ann Intern Med

    (2000)
  • M.E. Rinella et al.

    Body mass index as a predictor of hepatic steatosis in living liver donors

    Liver Transplantation

    (1993)
  • S.N. Blair et al.

    Physical fitness and incidence of hypertension in healthy normotensive men and women

    JAMA

    (1984)
  • S.N. Blair et al.

    Physical fitness and all-cause mortalitya prospective study of healthy men and women

    JAMA

    (1989)
  • S.N. Blair et al.

    Changes in physical fitness and all-cause mortalitya prospective study of healthy and unhealthy men

    JAMA

    (1995)
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    Supported in part by U.S. Public Health Service research grant AG06945 from the National Institute on Aging, and grant HL62508 from the National Heart, Lung, and Blood Institute.

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