Higher Healthy Lifestyle Score is associated with lower presence of Non-alcoholic fatty liver disease in middle-aged and older Chinese adults: a community-based cross-sectional study.

OBJECTIVE Previous studies have reported inverse associations between certain healthy lifestyle factors and Non-alcoholic fatty liver disease (NAFLD), but limited evidence showed the synergistic effect of those lifestyles. This study examined the relationship of a combination of lifestyles, expressed as Health Lifestyle Score (HLS), with NAFLD. DESIGN A community-based cross-sectional study. Questionnaires and body assessments were used to collect data on the 6-item HLS (ranging from 0-6, where higher scores indicate better health). The HLS consists of non-smoking (no active or passive smoking), normal BMI (18.5-23.9 kg/m2), physical activity (moderate or vigorous physical activity ≥ 150 min/week), healthy diet pattern, good sleep (no insomnia or < 6 months), and no anxiety (Self-rating Anxiety Scale < 50), one point each. NAFLD was diagnosed by ultrasonography. SETTING Guangzhou, China. PARTICIPANTS 2981 participants aged 40-75 years. RESULTS The overall prevalence of NAFLD was 50.8%. After adjusting for potential covariates, HLS was associated with lower presence of NAFLD. The ORs (95% CI) of NAFLD for subjects with higher HLS (3, 4, 5-6 vs. 0-1 points) were 0.68 (0.51,0.91), 0.58 (0.43,0.78) and 0.35 (0.25,0.51), respectively (P-values < 0.05). Among the 6 items, BMI and physical activity were the strongest contributors. Sensitivity analyses showed that the association was more significant after weighting the HLS. The beneficial association remained after excluding any one of the 6 components or replacing BMI with waist circumference. CONCLUSION Higher HLS was associated with lower presence of NAFLD, suggesting that a healthy lifestyle pattern might be beneficial to liver health.