Purpose. Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent liver disease in U.S. adults.  Physical activity and dietary behaviors have established protective associations with NAFLD and its severity; however, the associations of these lifestyle behaviors with NAFLD has not been well characterized in a representative sample of U.S. adults using imaging. The purpose of this study was to assess the association of lifestyle behaviors with NAFLD and advanced fibrosis as ascertained by vibration controlled transient elastography (VCTE; FibroScan®) with controlled attenuation in U.S. adults.

Methods. This cross-sectional analysis uses data from 2017–2018 National Health and Nutrition Examination Survey (NHANES). NAFLD was defined as controlled attenuation parameter (CAP)≥285 dB/m, and advanced fibrosis as liver stiffness measurements ≥8.6 kPa. Multivariate-adjusted logistic regression models assessed associations of physical activity and sedentary behavior (Global Physical Activity Questionnaire), as well as diet quality (Healthy Eating Index [HEI]-2015) and total energy intake (24-hour recall) with NAFLD and advanced fibrosis.

Results. The overall prevalence of NAFLD was 35.6%, while the prevalence of advanced fibrosis among those with NAFLD was 5.6%. We found that higher levels of physical activity and high diet quality were associated with lower risk of NAFLD. Compared to those reporting on average <4.67 metabolic equivalent (MET) hours/week of physical activity, participants reporting 4.67 – 60 MET hours of physical activity/week) had 65% lower risk of NAFLD (Adjusted OR=0.65, 95%CI 0.42, 0.99) and those reporting (≥60 MET hours/week had 65% lower risk of advanced fibrosis (Adjusted OR=0.35, 95%CI 0.16, 0.75). High diet quality (HEI-2015) was associated with a 40% lower risk of NAFLD (Adjusted OR=0.60, 95% CI 0.44, 0.84), as compared to those who reported low diet quality. As compared to adults with both low HEI-2015 and high total energy intake, those with combined highest levels of HEI and lowest total energy intake had 82% lower risk of advanced fibrosis.  

Conclusions. In this population-based study, increased physical activity and high diet quality were associated with NAFLD and advanced fibrosis. Public health and medical professionals need to concentrate efforts on lifestyle behavior change in U.S. adults who are at high risk for serious liver disease.

Purpose. The purpose of this qualitative research was to assess Mexican-origin men’s knowledge and cultural attitudes toward NAFLD and their interest in risk reduction.

Methods. Semi-structured interviews were conducted with 11 Spanish speaking Mexican-origin men who were considered high-risk of having NAFLD according to vibration controlled transient elastography (VCTE; FibroScan®) continuous attenuation parameter (CAP) scores (≥280). Audio recordings of these interviews were transcribed and interpreted in their respective language to facilitate data analysis using NVivo 12. A thematic codebook was developed, from which the research team identified emerging themes.

Results. Findings demonstrated limited knowledge about NAFLD and in general about chronic liver disease among Mexican-origin men. Cultural attitudes appeared to both enhance and mitigate their perceived risk for NAFLD. Interviews also revealed high levels of interest in reducing NAFLD risk, with family and loved ones acting as the main motivators for engagement in healthier lifestyle behaviors. This high-risk population was interested in the potential of family-based lifestyle interventions.

Conclusion: This qualitative study suggests that the development of a NAFLD-specific intervention approach for Mexican-origin men may be feasible and should consider a familial and cultural context centered in improving lifestyle health behaviors.

Purpose: Clinical guidelines recommend weight loss to manage non-alcoholic fatty liver disease (NAFLD), however many find dietary behavior change to initiate and sustain weight loss a significant challenge. We aimed to determine whether a very low-calorie diet (VLCD) is an acceptable and feasible approach to achieve and maintain 10% weight loss in adults with clinically significant NAFLD. Following completion of the 8-12 week VLCD, we interviewed participants to identify factors associated with uptake and adherence.

Methods: 23/30 participants who were enrolled in a pilot study of the VLCD (~800 kcal/day) took part in a semi-structured qualitative interview. Interviews were audio recorded, transcribed verbatim and thematically analyzed.

Results: 30 adults agreed to participate in the pilot study and 27 (90%) completed the VLCD intervention. 20 (67%) were retained at 9-month follow-up. The VLCD was acceptable and feasible to deliver. 34% of participants achieved and sustained 10% weight loss, 51% achieved 7% weight loss, and 68% achieved 5% weight loss. Five main themes were identified from post-intervention semi-structured interviews. A desire to achieve rapid weight loss to improve liver health and prevent disease progression was the most salient facilitator to uptake. Early and significant weight loss; accountability to clinicians; personalized feedback and the desire to receive positive reinforcement from a consultant were facilitators to adherence. Practical and emotional support from friends and family members were important for self-regulation. Irregular working patterns that prevented attendance at appointments were barriers to adherence and completion of the intervention.

Conclusions: A VLCD offers an acceptable and feasible treatment option for NAFLD to enable a sustainable 10% weight loss that can improve liver health, cardiovascular risk, and quality of life. Uptake and adherence rely on early and rapid weight loss. Personalized feedback and positive reinforcement in the clinical setting, combined with ongoing social and practical support from friends and family members is important for self-regulation. Findings highlight the importance of intensive behavioral support during the early stages of dietary behavior change using a VLCD approach.