Physical activity substantially cuts cirrhosis risk in MASLD patients

A study presented at DDW 2024 showed that adequate physical activity reduces the risk of cirrhosis in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD).

The association between sufficient physical exercise and decreased risk of cirrhosis was significant on univariate analysis (odds ratio [OR], 0.44, 95 percent confidence interval [CI], 0.27–0.71; p<0.001).

The significant association was sustained on multivariate analysis after accounting for factors associated with cirrhosis, including age, gender, BMI, diabetes, hypertension, and dyslipidaemia (OR, 0.27, 95 percent CI, 0.13–0.55; p<0.001). [DDW 2024, abstract Su1532]

Moreover, participants who had adequate physical activity had a higher health-related quality of life score as opposed to those who had insufficient physical activity (mean Short Form-8 score, 73 vs 66; p=0.0057).

Movement matters

About a third of adults in the US have MASLD, which is a leading cause of liver-related complications, noted study first author Blake Czapla, research assistant from the Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, US, in the poster presentation. “MASLD is strongly associated with physical inactivity, but prospective data on associations between physical activity, disease severity, and other lifestyle factors are limited.”

Hence, Czapla and colleagues sought to evaluate the effect of physical activity on health outcomes by using data from the Michigan Liver Steatosis cohort, a biorepository and prospective cohort based at the University of Michigan which enrols MASLD patients and follows them in the hepatology clinic. Physical activity was measured by the Global Physical Activity Questionnaire (GPAQ).

A total of 277 participants (out of 553) completed the GPAQ. Of these, 131 reported engaging in adequate physical activity while 146 did not. The mean age was 57 years, 51.9 percent were women, and mean BMI was 33.5 kg/m². About half (47.6 percent) of the participants had hypertension, 41.9 percent had dyslipidaemia, and 41.8 percent had diabetes. Nearly two-thirds (60.9 percent) had cirrhosis. Mean liver stiffness as measured by vibration-controlled transient elastography was 7.1 kPa.

According to Czapla and colleagues, these characteristics are as expected for a cohort comprising individuals with MASLD.

Compared with those who had insufficient physical activity, participants who reported having adequate exercise had lower BMI (32 vs 35 kg/m²; p=0.012) and lower incidence of cirrhosis (45 percent vs 65 percent; p=0.0008). There were similar mean liver stiffness measurements between those who did and did not have adequate physical activity (6.4 vs 8.1 kPa; p=0.1135).

Vital to MASLD management, prevention

In March 2024, the US FDA has given the nod for resmetirom for the management of adults who have noncirrhotic nonalcoholic steatohepatitis (a form of fatty liver) with moderate-to-advanced liver fibrosis. [https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-patients-liver-scarring-due-fatty-liver-disease]

Of note, the recommendation stipulates that the drug should be used in “addition to diet and exercise”, thus underpinning the importance of lifestyle modifications despite the emergence of treatment alternatives.

In another report, it was stressed that even with approved medications, “regular physical activity, which is most effectively accomplished through a formal and supported exercise training programme, will continue to be a vital component, not only in the clinical management of [MASLD] but also in its prevention.” [Nutrients 2023;15:2452]