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A healthy lifestyle reduces risk of developing severe liver disease in women

by Narges Mohammadi

In a recent study published in Metabolism, researchers investigate the correlation between a healthy lifestyle and Life’s Essential 8 (LE8) scores in new-onset severe non-alcoholic fatty liver disease (NAFLD).

Approaches to mitigate the effects of NAFLD

NAFLD is a significant cause of hepatocellular carcinoma and cirrhosis, as well as cardiovascular disease (CVD). However, the relationship between new-onset NAFLD and a healthy lifestyle remains unclear.

The American Heart Association (AHA) created Life’s Simple 7 (LS7) in 2010, which offers patient-centered guidelines for CV health (CVH). LS7 consists of four health behaviors, including body mass index (BMI), physical activity, diet, and smoking, as well as three health factors, including blood glucose, blood lipids, and blood pressure.

Recently, the AHA described a new method for measuring CVH called Life’s Essential 8 (LE8), which is an updated and improved way of defining and quantifying CVH.

About the study

The United Kingdom Biobank gathered data from more than 500,000 participants between 40 and 70 years of age throughout the U.K. between 2006 and 2010. This data included participants’ physical measurements, questionnaires, sample assays, and longitudinal follow-up for various health-related outcomes.

Variables for a healthy lifestyle were developed using six established risk factors, including BMI, smoking habits, alcohol consumption, sleep duration, physical activity, and dietary consumption. A standardized touchscreen questionnaire was used for the baseline assessment of the participants. Overall, lifestyle factors were classified as ideal, intermediate, or poor.

The LE8 diet score was graded based on a point system. Scoring eight or higher earned 100 points, scoring between six and eight earned 80 points, scoring between four and six earned 50 points, scoring between two and four earned 25 points, and scoring less than two earned zero points.

The primary outcome of the study was the occurrence of new-onset severe NAFLD, whereas the secondary outcome was new-onset severe liver disease, including compensated or decompensated liver cirrhosis, hepatocellular carcinoma, liver failure, and liver-related mortality.

A healthy lifestyle reduces risk of NAFLD complications

The current study involved 2,66,645 participants, including 133,223 women with an average age of 56.4 years and an average LE8 score was 65.8. Moreover, 22,541 study participants were considered as having low CVH, 217,513 with moderate CVH, and 26,591 with high CVH.

Individuals with a high CVH tended to be younger, have higher levels of education, and have a lower deprivation index. This study cohort was also more likely to be women and White and less likely to be prescribed cholesterol-lowering, antihypertensive, and antidiabetic medications.

About 13.5% of participants had poor lifestyles, 76.8% had intermediate lifestyles, and 9.7% had ideal lifestyles. During a median follow-up period of almost 12 years, 0.9% of participants developed severe NAFLD.

A significant association was observed between each lifestyle factor and the risk of developing severe NAFLD. For example, participants with an ideal smoking level, alcohol intake, BMI, diet, physical activity, and sleep duration were less likely to develop new-onset severe NAFLD as compared to those with a poor lifestyle.

More Information

Participants with ideal or intermediate lifestyles were also less likely to develop new-onset severe NAFLD as compared to those with poor lifestyles. In fact, an ideal lifestyle at baseline could have prevented almost 67% of new-onset severe NAFLD cases compared to those with a combined intermediate/poor lifestyle.

The high and moderate CVH cohorts had a significantly lower likelihood of developing new-onset severe NAFLD than the low overall CVH cohort. Furthermore, high CVH could have prevented 77.3% of new-onset severe NAFLD.

A U-shaped correlation was observed between severe NAFLD risk and sleep duration, with the lowest risk reported at six to eight or fewer hours of sleep every night. Thus, sleep duration appears to be an independent contributor to health outcomes and should be considered as a CVH metric. The association remained significant after adjusting for other LE8 metrics and important covariates.

Approximately 1% of new-onset severe liver diseases were reported during the follow-up period. Furthermore, participants who led ideal or intermediate lifestyles were less likely to develop new-onset severe liver disease than those who led poor lifestyles. The likelihood of developing new-onset severe liver diseases was also significantly lower in the high and moderate CVH cohorts as compared to the low overall CVH group.


Individuals who maintain a healthy lifestyle and have a higher LE8 score are less likely to develop severe NAFLD, irrespective of their genetic predisposition. Following a healthy lifestyle and achieving a higher LE8 score could prevent almost 67% and 77% of severe NAFLD cases. These findings suggest that encouraging a healthy lifestyle and achieving a higher LE8 score could potentially prevent NAFLD.

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