# Association between Lifestyle Modification and All-Cause, Cardiovascular, and Premature Mortality in Individuals with Non-Alcoholic Fatty Liver Disease

## TL;DR

Adopting healthy lifestyle habits significantly reduces mortality risks in people with non-alcoholic fatty liver disease, especially for women and those who are obese.

## Contribution

This study demonstrates that a favorable lifestyle significantly reduces all-cause and cardiovascular mortality in NAFLD patients.

## Key findings

- NAFLD patients with favorable lifestyles had a 56% lower all-cause mortality risk and 66% lower CVD mortality risk.
- Maintaining a non-depressed mental state and vigorous exercise reduced CVD mortality risk by 36% and 46%, respectively.
- Healthy sleep reduced premature CVD mortality by 31% in NAFLD patients.

## Abstract

Background: This study is designed to explore the correlation between multiple healthy lifestyles within the framework of “lifestyle medicine”, and the mortality risk of nonalcoholic fatty liver disease (NAFLD). Methods: The National Health and Nutrition Examination Survey (NHANES) database was employed. The analysis consisted of 5542 participants with baseline NAFLD and 5542 matched non-NAFLD participants from the database. Lifestyle information, including five low risk factors advocated by lifestyle medicine (healthy diet, vigorous physical activity, healthy sleep duration, avoiding smoking, and maintaining a non-depressed psychological status), was collected through a baseline questionnaire. Cox proportional hazards regression models and Kaplan–Meier survival curve were used to evaluate risk of mortality. In addition, subgroups were analyzed according to gender, age, body mass index and waist circumference. Results: In total, 502 deaths (n = 181 deaths from cardiovascular disease (CVD)) were recorded among NAFLD participants after the median follow up duration of 6.5 years. In the multivariate-adjusted model, compared to participants with an unfavorable lifestyle (scoring 0–1), NAFLD participants with a favorable lifestyle (scoring 4–5) experienced a 56% reduction in all-cause mortality and a 66% reduction in CVD mortality. Maintaining an undepressed psychological state and adhering to vigorous exercise significantly reduced CVD mortality risk in NAFLD participants (HR, 0.64 [95% CI, 0.43–0.95]; HR, 0.54 [95% CI, 0.33–0.88]) while maintaining healthy sleep reduced premature mortality due to CVD by 31%. Conclusions: Healthy lifestyle, characterized by maintaining an undepressed mental state and healthy sleep, significantly mitigates the risk of all-cause, CVD, and premature mortality risk among NAFLD patients, with a particularly pronounced effect observed in female and obese subpopulations.