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
ARTICLE HIGHLIGHTS
Research background

Since one potential intervention for nonalcoholic fatty liver disease (NAFLD) is increasing levels of physical activity, it is important to consider the potential impact of depressive symptoms on the likelihood of participating in physical activity. It has been well established that individuals with depressive symptoms are less adherent to treatment for chronic illness, particularly treatments that involve behavioral changes.

Research motivation

Previous research has demonstrated the relationship between NAFLD and physical inactivity, between NAFLD and depressive symptoms, and between physical inactivity and depressive symptoms; however, we were not able to identify previous literature that explored the interaction of NAFLD, physical inactivity, and depressive symptoms together.

Research objectives

The current investigation assesses the presence of NAFLD, physical inactivity, and depressive symptoms in a community sample in order to explore the potential interrelationships.

Research methods

Data from the Rancho Bernardo Study were used. 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.

Research 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.

Research conclusions

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.

Research perspectives

Further investigation is needed to clarify this bi-directional relationship between depression and NAFLD. Future work should explore screening for the combined presence of NAFLD and depression to determine if treatment with appropriate physical activity interventions can enhance outcomes.