不同类型的肥胖在体力活动水平与代谢功能障碍相关脂肪肝关联中的修饰作用

常洋; 李佳蔚; 吴功华; 张菊英; 郭冰; 赵星

doi:10.12182/20250160108

不同类型的肥胖在体力活动水平与代谢功能障碍相关脂肪肝关联中的修饰作用

Different Types of Obesity Play a Modifying Role in the Association Between Physical Activity and Metabolic Dysfunction-Associated Fatty Liver Disease

摘要

摘要:
目的探讨体力活动水平与代谢功能障碍相关脂肪肝（metabolic dysfunction-associated fatty liver disease, MAFLD）的关联以及不同类型肥胖在其中的效应修饰作用。
方法对中国西南区域自然人群队列成都子队列2018–2019年招募的19925名参与者进行横断面研究。采用广义倾向评分（generalized propensity score, GPS）逆概率加权法（inverse probability weighting, IPW）研究体力活动与MAFLD患病率之间的关联。以轻度体力活动组作为参考组，计算中度、剧烈体力活动的比值比（odds ratio, OR）及其95%置信区间（confidence interval, CI）。利用限制性三次立方样条函数拟合体力活动与MAFLD患病风险的暴露-反应关系。评估肥胖类型在不同性别人群中对体力活动与MAFLD关联的潜在效应修饰作用。
结果 MAFLD的患病率为17.30%。从事剧烈、中度的体力活动分别比从事轻度体力活动的人患MAFLD风险低，OR（95%CI）分别为0.76（0.67，0.86）、0.85（0.76，0.94）。暴露-反应关系显示体力活动与MAFLD风险呈非线性关系（P_非线性=0.005），当体力活动达到约20 METs-h/d时，对MAFLD患病风险的保护作用开始显现；然而，当体力活动增至超过70 METs-h/d后，其对MAFLD患病风险无显著作用。在女性人群中，肥胖类型对体力活动与MAFLD的关联具有效应修饰作用（P<0.05）。对于中心型肥胖女性，体力活动对MAFLD 的保护作用呈阈值效应，体力活动量约为25 METs-h/d时，患病风险最低，但超过约37.5 METs-h/d时，体力活动与MAFLD患病风险的关联无统计学意义；而对于周围型肥胖女性，高体力活动对降低MAFLD患病风险的作用有限。
结论适度的体力活动可显著降低MAFLD患病风险，肥胖类型可修饰二者之间的关联。推荐参与者体力活动达到约20～70 METs-h/d。建议中心型肥胖女性的体力活动量不超过37.5 METs-h/d，周围型肥胖女性则不超过30 METs-h/d。

Abstract:
Objective To explore the association between physical activity levels and metabolic dysfunction-associated fatty liver disease (MAFLD) and the modifying effects of different types of obesity.
Methods A cross-sectional study was conducted on 19925 participants recruited from the Chengdu sub-cohort of the Southwest China Natural Population Cohort. The participants were recruited between 2018 and 2019. The association between physical activity and MAFLD prevalence was examined using the inverse probability weighting (IPW) method based on the generalized propensity score (GPS). The odds ratios (OR) and the 95% confidence interval (CI) for moderate and vigorous physical activity were calculated using the mild physical activity group as a reference. A restricted cubic spline function was used to model the exposure-response relationship between physical activity and MAFLD risk. The potential modifying effects of obesity types on the association between physical activity and MAFLD were evaluated in male and female populations.
Results The prevalence of MAFLD was 17.30%. Compared to those engaging in mild physical activity, individuals participating in vigorous and moderate physical activities had a lower risk of MAFLD, with OR (95% CI) being 0.76 (0.67, 0.86) and 0.85 (0.76, 0.94), respectively. The exposure-response relationship showed a nonlinear association between physical activity and MAFLD risks (P_nonlinearity = 0.005). The protective effect of physical activity against MAFLD was observed when physical activity reached approximately 20 METs-h/d. However, when physical activity exceeded 70 METs-h/d, no significant effect on MAFLD risk was observed. Among the female population, obesity type significantly modified the association between physical activity and MAFLD (P < 0.05). In females with central obesity, the protective effect of physical activity on MAFLD showed a threshold effect, with the lowest disease risk observed at approximately 25 METs-h/d. However, physical activity exceeding 37.5 METs-h/d showed no statistically significant association with MAFLD risk. In contrast, for females with peripheral obesity, high levels of physical activity had limited effects on reducing MAFLD risks.
Conclusion Moderate physical activity can significantly reduce the risk of MAFLD, and the obesity types can modify this association. It is recommended that individuals engage in approximately 20-70 METs-h/d of physical activity. For females with central obesity, physical activity should not exceed 37.5 METs-h/d, while for females with peripheral obesity, it should not exceed 30 METs-h/d.

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