身体活动与最少加工食物对美国代谢功能障碍相关脂肪性肝病死亡风险的独立及联合关联:基于NHANES的人群队列研究OA

Objective To evaluate the independent and joint associations of physical activity(PA)and minimally processed food(MPF)intake with the mortality risk among patients with metabolic dysfunction-associated steatotic liver disease(MASLD).Methods Data from the National Health and Nutrition Examination Survey(NHANES)2007-2018 were utilized,and a total of 1825 patients with MASLD were enrolled.PA levels were quantified as metabolic equivalent minutes per week(MET-min/week)using the Global Physical Activity Questionnaire(GPAQ).MPF intake was calculated based on 24-hour dietary recalls and classified in accordance with the NOVA food processing classification system.Cox proportional hazards models were used to evaluate the associations of PA and MPF intake with all-cause mortality,cardiovascular mortality,and non-cardiovascular mortality in MASLD patients.Joint association analyses and restricted cubic spline(RCS)dose-response analysis were further performed.Sensitivity analyses were conducted by modifying the diagnostic cut-off values for MASLD[fatty liver index(FLI)>30,United States fatty liver index(US-FLI)>60,and US-FLI>30]and excluding individuals who died within the first 24 months of follow-up.Results During a median follow-up of 87 months,149 deaths occurred among 1825 enrolled patients,including 45 cardiovascular deaths and 104 non-cardiovascular deaths.In the fully adjusted model,high PA(≥1500 MET-min/week)showed a marginal increasing trend in all-cause mortality risk(HR=1.14,95%CI 1.00-1.29),whereas higher MPF intake was significantly associated with reduced risk of all-cause mortality(HR=0.73,95%CI 0.65-0.81),cardiovascular mortality(HR=0.73,95%CI 0.65-0.82),and non-cardiovascular mortality(HR=0.73,95%CI 0.65-0.82).Joint analysis demonstrated that the group with high MPF intake and low PA had the lowest mortality risk(all-cause mortality:HR=0.75,95%CI 0.63-0.88;cardiovascular mortality:HR=0.76,95%CI 0.64-0.90;non-cardiovascular mortality:HR=0.76,95%CI 0.64-0.91).RCS analysis revealed significant nonlinear associations between PA and risks of all-cause,cardiovascular,and non-cardiovascular mortality(all-cause mortality:Pnon-linear=0.0002;cardiovascular mortality:Pnon-linear=0.0003;non-cardiovascular mortality:Pnon-linear=0.0002).Although the associations between MPF intake and the three types of mortality presented an overall approximately linear downward trend,non-linear tests indicated that these associations were not strictly linear(all-cause mortality:Pnon-linear=0.05,cardiovascular mortality:Pnon-linear=0.0107;non-cardiovascular mortality:Pnon-linear=0.0057).Sensitivity analyses confirmed the robustness of the primary findings.Conclusions Among patients with MASLD,high-level PA is not a simple protective factor,whereas high MPF intake is generally associated with lower mortality risk.Joint analysis suggested that dietary optimization may be more critical than simply increasing physical activity.The combination of moderate PA and higher MPF intake may represent an optimal lifestyle pattern for the MASLD population,providing evidence-based references for individualized management and public health interventions.