Association between hepatic steatosis and fibrosis indices and dietary habits, physical activity, and quality of life

The global population is currently facing an epidemic of obesity and type 2 diabetes mellitus (T2DM), both of which are related to excessive caloric intake and increasing physical inactivity. Nonalcoholic fatty liver disease (NAFLD) has been strongly associated with obesity, T2DM, and metabolic syndrome (MetS) in a bidirectional mode [1]. NAFLD is a potentially novel epidemic that has conditioned to spread, with a global prevalence estimated to be around 25% [2]. However, for this highly prevalent condition, disease awareness among patients and clinicians still remains low [3].

NAFLD is strongly associated with lifestyle characteristics, such as diet and physical activity (PA). Several patients with NAFLD have adopted a hypercaloric Western diet, which has been correlated with hepatic steatosis and increase in alanine aminotransferase (ALT) even in apparently healthy people [4]. In contrast, the Mediterranean diet (MD), which differs largely from the Western diet, has been considered effective and balanced, proposed to offer benefits in NAFLD patients [5]. Additionally, NAFLD patients are usually characterized by two behaviors: (1) lower grade of PA (or physical inactivity) and (2) prolonged sedentary time. Several studies have reported that these two types of behavior independently promote increased risk for NAFLD [6], [7].

Limited data exist on the evaluation of quality of life (QoL) in patients with NAFLD, who probably exhibit reduced QoL scores compared to the general population [8]. Within the spectrum of the disease, patients with nonalcoholic steatohepatitis (NASH) present with even lower QoL compared to those without NASH. Moreover, hepatic fibrosis is another predictor of reduced QoL scores. Patients with advanced fibrosis have been reported to present with lower QoL compared to those with moderate fibrosis [9]. Finally, patients with NASH-related cirrhosis exhibited, as expected, the most significant decline in QoL, especially in the area of physical function [10].

The current study aimed to determine whether non-invasive hepatic steatosis and fibrosis indices of NAFLD were associated with adherence to the MD pattern, PA, and QoL in young-to-middle aged individuals who were unaware of the status of their liver disease.

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