Physical activity and risk of fatty liver in people with different levels of alcohol consumption: a prospective cohort study

Objective: To investigate whether physical activity affects the future incidence of fatty liver in people with never-moderate and heavy alcohol consumption. Design: Prospective cohort study. Setting: Health check-up programme at Meiji Yasuda Shinjuku Medical Center in Shinjuku Ward, Tokyo, Japan. Population: A total of 10 146 people aged 18 years or older without fatty liver enrolled through baseline surveys conducted from 2005 to 2007. They were grouped into never-moderate alcohol drinkers (n=7803) and heavy alcohol drinkers (n=2343) and followed until 2013. Main outcome measure: Incident fatty liver diagnosed by ultrasound. Results: During a mean follow-up of 4.4 years (34 648 person-years), 1255 never-moderate alcohol drinkers developed fatty liver; 520 heavy alcohol drinkers developed fatty liver during a mean follow-up of 4.1 years (9596 person-years). For never-moderate alcohol drinkers, engaging in >3x/week of low-intensity (HR=0.82, 95% CI 0.71 to 0.96) and moderate-intensity (HR=0.56, 95% CI 0.39 to 0.81) physical activity significantly reduced incident fatty liver compared with those who engaged in physical activity <1x/week. For vigorous-intensity physical activity, frequencies of 2x/week (HR=0.57, 95% CI 0.38 to 0.86) and >3x/week (HR=0.55, 95% CI 0.38 to 0.79) were significantly associated with lower risk of incident fatty liver. In propensity-adjusted models, these significant associations still remained. By contrast, in heavy alcohol drinkers, there were no significant associations between the type or frequency of physical activity and incident fatty liver. Conclusions: Physical activity had an independent protective effect on incident fatty liver only in the never-moderate alcohol drinkers, and the preventive effect increased with higher frequencies and intensities of physical activity.