# Association of physical fitness with visceral fat status and metabolic dysfunction-associated fatty liver disease in individuals with spinal cord injury using manual wheelchair in Korea

## TL;DR

This study found that lower physical fitness in individuals with spinal cord injury is linked to higher visceral fat and a liver disease called MAFLD.

## Contribution

The study is the first to explore the relationship between physical fitness and MAFLD in spinal cord injury patients in Korea.

## Key findings

- Lower physical fitness was associated with increased visceral fat and higher fatty liver index scores.
- The low fitness group had significantly higher odds of abnormal visceral fat and MAFLD compared to the high fitness group.
- Flexibility was reduced in individuals with abnormal visceral fat.

## Abstract

This study aimed to investigate the association of physical fitness with visceral fat status and metabolic dysfunction-associated fatty liver disease (MAFLD) in individuals with spinal cord injury (SCI) in Korea.

This cross-sectional study included 113 individuals with SCI (aged ≥40 years; women, 19.5 %) who were receiving care at the disability welfare facilities in G and C Provinces. Data were collected from October 2022 to August 2024. The new visceral adiposity index was used to evaluate visceral fat status. MAFLD was assessed using fatty liver index (FLI), type 2 diabetes, body mass index, and metabolic risk factors. Physical fitness was measured by muscular strength, muscular endurance, flexibility, and cardiorespiratory endurance. After adjusting for age and sex, the participants were grouped into high, middle, and low fitness groups. The odds ratio (OR) and 95 % confidence interval (CI) for abnormal visceral adiposity and MAFLD, according to the fitness level, was calculated using binary logistic regression analysis.

As the physical fitness level was decreasing, a significant linear trend toward increasing new visceral adiposity index (p < 0.01) and FLI (p < 0.01) scores were observed. The low fitness group exhibited a higher OR for abnormal visceral adiposity (OR = 3.64, 95 % CI = 1.28–10.37) and MAFLD (OR = 4.39, 95 % CI = 1.48–13.03) than the high fitness group (OR = 1.00).

The findings of this study suggest that improving physical fitness through various regular exercise range may be influential in maintaining an appropriate visceral fat status and preventing MAFLD in individuals with SCI.

•Flexibility was lower with abnormal visceral fat than with normal visceral fat.•Low fitness group had higher risk of abnormal visceral fat than high fitness group.•They also had higher metabolic dysfunction-associated fatty liver disease risk.

Flexibility was lower with abnormal visceral fat than with normal visceral fat.

Low fitness group had higher risk of abnormal visceral fat than high fitness group.

They also had higher metabolic dysfunction-associated fatty liver disease risk.