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Background <p>Lifestyle factors strongly affect the prevention and improvement of liver-related outcomes. However, the relationship between combined lifestyle factors and metabolic dysfunction-associated steatotic liver disease (MASLD) has not been comprehensively evaluated. Therefore, this study aimed to investigate the association between a combination of healthy lifestyle factors and MASLD in Korean adults.</p> Methods <p>This study analyzed data from 23,111 participants aged 19–80 years who were enrolled in the Korean National Health and Nutrition Examination Survey (2016–2021). A healthy lifestyle was defined based on four factors including diet quality, physical activity, smoking, and sleep duration. Participants were divided into three groups based on healthy lifestyle score ranging from 0 to 4. MASLD was defined as having both hepatic steatosis index ≥ 36 and cardiometabolic risk factor ≥ 1. Multivariate logistic regression analysis was conducted to identify the associations between healthy lifestyles and the risk of MASLD. Additional analyses were conducted based on the combination of lifestyle factors.</p> Results <p>The weighted prevalence of MASLD was 24.1%, with the highest rates observed in participants with an unfavorable lifestyle. The protective effect against the risk of MASLD increased with the number of lifestyle factors. Compared to individuals in the unfavorable lifestyle group, the multivariate-adjusted odds ratio for MASLD was 0.825 (95% confidence interval [CI], 0.728–0.935) for the intermediate lifestyle group and 0.714 (95% CI, 0.621–0.820) for the favorable lifestyle group. A significant association was found among individuals with combinations of healthy lifestyle factors, and the lowest risk was observed in those with combined diet, physical activity, and smoking, with an odds ratio of 0.680 (95% CI, 0.544–0.848).</p> Conclusions <p>In this study, healthy lifestyle factors were inversely associated with MASLD risk. However, due to the cross-sectional design, causal relationships cannot be established, and future longitudinal studies are warranted to confirm these associations. From a public health perspective, our findings support the importance of promoting healthy lifestyle behaviors, particularly smoking cessation and regular physical activity, as potential strategies for MASLD prevention.</p>

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Association of combined healthy lifestyle factors with the risk of metabolic dysfunction-associated steatotic liver disease: the Korean National Health and Nutrition Examination Survey 2016–2021

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  • 发表日期：

    2026年6月24日

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  • Na-Noom Jeong,
  • Hyun Joung Lim,
  • Won-Ho Kim,
  • Min-Ju Kim

摘要

Background

Lifestyle factors strongly affect the prevention and improvement of liver-related outcomes. However, the relationship between combined lifestyle factors and metabolic dysfunction-associated steatotic liver disease (MASLD) has not been comprehensively evaluated. Therefore, this study aimed to investigate the association between a combination of healthy lifestyle factors and MASLD in Korean adults.

Methods

This study analyzed data from 23,111 participants aged 19–80 years who were enrolled in the Korean National Health and Nutrition Examination Survey (2016–2021). A healthy lifestyle was defined based on four factors including diet quality, physical activity, smoking, and sleep duration. Participants were divided into three groups based on healthy lifestyle score ranging from 0 to 4. MASLD was defined as having both hepatic steatosis index ≥ 36 and cardiometabolic risk factor ≥ 1. Multivariate logistic regression analysis was conducted to identify the associations between healthy lifestyles and the risk of MASLD. Additional analyses were conducted based on the combination of lifestyle factors.

Results

The weighted prevalence of MASLD was 24.1%, with the highest rates observed in participants with an unfavorable lifestyle. The protective effect against the risk of MASLD increased with the number of lifestyle factors. Compared to individuals in the unfavorable lifestyle group, the multivariate-adjusted odds ratio for MASLD was 0.825 (95% confidence interval [CI], 0.728–0.935) for the intermediate lifestyle group and 0.714 (95% CI, 0.621–0.820) for the favorable lifestyle group. A significant association was found among individuals with combinations of healthy lifestyle factors, and the lowest risk was observed in those with combined diet, physical activity, and smoking, with an odds ratio of 0.680 (95% CI, 0.544–0.848).

Conclusions

In this study, healthy lifestyle factors were inversely associated with MASLD risk. However, due to the cross-sectional design, causal relationships cannot be established, and future longitudinal studies are warranted to confirm these associations. From a public health perspective, our findings support the importance of promoting healthy lifestyle behaviors, particularly smoking cessation and regular physical activity, as potential strategies for MASLD prevention.