Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2022; 14(3): 612-622
Published online Mar 27, 2022. doi: 10.4254/wjh.v14.i3.612
Interrelationship between physical activity and depression in nonalcoholic fatty liver disease
Ali A Weinstein, Leyla De Avila, Saisruthi Kannan, James M Paik, Pegah Golabi, Lynn H Gerber, Zobair M Younossi
Ali A Weinstein, Leyla De Avila, James M Paik, Pegah Golabi, Lynn H Gerber, Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, United States
Ali A Weinstein, Saisruthi Kannan, Global and Community Health, George Mason University, Fairfax, VA 22030, United States
Lynn H Gerber, Zobair M Younossi, Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA 22042, United States
Zobair M Younossi, Inova Medicine, Inova Health System, Falls Church, VA 22042, United States
Author contributions: Weinstein AA, de Avila, L, Golabi P, Gerber LH, and Younossi ZM designed the research study; Paik JM analyzed the data; and Weinstein AA, Kannan S, de Avila L, and Paik JM wrote the manuscript; all authors have read and approve the final manuscript.
Supported by Betty and Guy Beatty Center for Integrated Research.
Institutional review board statement: This study is the analysis of de-identified, publicly available data and does not constitute human subjects research, therefore it does not need institutional review board approval.
Informed consent statement: This is a secondary data analysis of a publicly available deidentified data, therefore, informed ethics committee approval and informed consent is not relevant here. The original data collection adhered to all ethical standards (ethics committee approval and informed consent).
Conflict-of-interest statement: Dr. Zobair M Younossi is a consultant to BMS, Gilead, AbbVie, Intercept, and GSK. All other authors report no proprietary or commercial interest in any product or concept discussed in this article.
Data sharing statement: Data are available by request from https://knit.ucsd.edu/ranchobernardostudy/access/
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zobair M Younossi, AGAF, FACG, FACP, MD, Chairman, Professor, Inova Medicine, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA 22042, United States. zobair.younossi@inova.org
Received: October 19, 2021
Peer-review started: October 19, 2021
First decision: December 3, 2021
Revised: December 21, 2021
Accepted: February 20, 2022
Article in press: February 20, 2022
Published online: March 27, 2022
Processing time: 156 Days and 11.7 Hours
Abstract
BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is associated with a sedentary lifestyle and depressive symptoms. It is also well established that physical inactivity and depressive symptoms are related. However, an investigation of the interaction between all of these factors in NAFLD has not been previously conducted.

AIM

To investigate the interrelationship between physical inactivity and depressive symptoms in individuals with NAFLD.

METHODS

Data from the Rancho Bernardo Study of Healthy Aging were utilized. 589 individuals were included in the analyses (43.1% male; 95.8% non-Hispanic white; aged 60.0 ± 7.0 years). NAFLD was defined by using the hepatic steatosis index, depression using the Beck Depression Inventory, and physical activity by self-report of number of times per week of strenuous activity. Multivariable generalized linear regression models with Gamma distribution were performed to investigate the proposed relationship.

RESULTS

About 40% of the sample had evidence of NAFLD, 9.3% had evidence of depression, and 29% were physically inactive. Individuals with NAFLD and depression were more likely to be physically inactive (60.7%) compared to individuals with neither NAFLD nor depression (22.9%), individuals with depression without NAFLD (37.0%), and individuals with NAFLD without depression (33.3%). After accounting for various comorbidities (i.e., age, sex, diabetes, hypertension, obesity), individuals with NAFLD and higher levels of physical activity were at a decreased odds of having depressive symptoms [16.1% reduction (95% confidence interval: -25.6 to -5.4%), P = 0.004], which was not observed in those without NAFLD.

CONCLUSION

Individuals with NAFLD have high levels of physical inactivity, particularly those with depressive symptoms. Because this group is at high risk for poor outcomes, practitioners should screen for the coexistence of depressive symptoms and NAFLD. This group should receive appropriate interventions aimed at increasing both participation and levels of intensity of physical activity.

Keywords: Liver disease; Outcomes research; Psychiatric disorders; Exercise

Core Tip: Physical inactivity and depressive symptoms are common in individuals with nonalcoholic fatty liver disease (NAFLD). Individuals with both NAFLD and depression are more likely to be sedentary than individuals without NAFLD or in individuals with NAFLD without depressive symptoms. Because this group is at high risk for poor outcomes, practitioners should screen for the coexistence of depressive symptoms and NAFLD. This group should receive appropriate interventions aimed at increasing both participation and levels of intensity of physical activity. It is therefore desirable that individuals with NAFLD should be screened for the presence of depressive symptoms to help determine appropriate interventions.