{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:39:20Z","timestamp":1792373960063,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>We investigated whether accelerometer\u2010assessed moderate\u2010to\u2010vigorous physical activity (MVPA) is associated with cardiovascular mortality among individuals with metabolic dysfunction\u2010associated steatotic liver disease (MASLD) in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a longitudinal analysis using the 2003\u20132006 US National Health and Nutrition Examination Survey data among adults, with mortality follow\u2010up through December 2019. We defined MASLD primarily using the Hepatic Steatosis Index (HSI), followed by current cardiometabolic criteria; we used the US Fatty Liver Index (USFLI) in sensitivity analyses. We classified accelerometer\u2010assessed PA as MVPA, total PA, and sedentary behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2785 individuals with HSI\u2010defined MASLD, 584 deaths occurred, including 198 cardiovascular deaths, over a median follow\u2010up of 14.7\u2009years. A higher level of PA is associated with a more favorable predicted cardiovascular risk profile at baseline. Among individuals with MASLD, increasing MVPA was nonlinearly associated with reduced all\u2010cause mortality in a multivariable model (hazard ratio [HR]: 0.80, 95% CI: 0.71\u20130.91 per 10\u2010min increase; P for trend &lt;\u20090.001). Furthermore, higher MVPA was nonlinearly associated with a lower risk of cardiovascular mortality in MASLD (HR: 0.72, 95% CI: 0.53\u20130.99 per 10\u2010min increase; P for trend\u2009=\u20090.009). Although higher total PA was also associated with reduced mortality, the point estimate was substantially weaker than that observed for MVPA. Sensitivity analyses using the USFLI definition showed directionally similar but attenuated associations. Increased sedentary behavior did not impact mortality in the MASLD group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher MVPA is nonlinearly associated with cardiovascular mortality in individuals with MASLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.70826","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:41:12Z","timestamp":1792370472000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Physical Activity on Cardiovascular Outcomes in Metabolic Dysfunction\u2010Associated Steatotic Liver Disease"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1919-6800","authenticated-orcid":false,"given":"Donghee","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9121-165X","authenticated-orcid":false,"given":"Pojsakorn","family":"Danpanichkul","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Texas Tech University Health Sciences Center  Lubbock Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2815-1105","authenticated-orcid":false,"given":"Do Han","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0592-490X","authenticated-orcid":false,"given":"Donghyun","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Medicine, Bridgeport Hospital Yale New Haven Health  Bridgeport Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-6343","authenticated-orcid":false,"given":"Karn","family":"Wijarnpreecha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &amp; Hepatology Mayo Clinic College of Medicine  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3609-8586","authenticated-orcid":false,"given":"Aijaz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.3350\/cmh.2024.0987","article-title":"Current Burden of Steatotic Liver Disease and Fibrosis Among Adults in the United States, 2017\u20102023","volume":"31","author":"Kim D.","year":"2025","journal-title":"Clinical and Molecular Hepatology"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2026.0444"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1097\/HEP.0000000000000670","article-title":"Metabolic Dysfunction\u2010Associated Steatotic Liver Disease: Update and Impact of New Nomenclature on the American Association for the Study of Liver Diseases Practice Guidance on Nonalcoholic Fatty Liver Disease","volume":"79","author":"Kanwal F.","year":"2024","journal-title":"Hepatology"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.7326\/ANNALS-24-03218","article-title":"Trends in Mortality From Chronic Liver Disease Before, During, and After the COVID\u201019 Pandemic, 2015 to 2023","volume":"178","author":"Kim D.","year":"2025","journal-title":"Annals of Internal Medicine"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3350\/cmh.2024.0631","article-title":"Long\u2010Term Outcomes and Risk Modifiers of Metabolic Dysfunction\u2010Associated Steatotic Liver Disease Between Lean and Non\u2010Lean Populations","volume":"31","author":"Danpanichkul P.","year":"2025","journal-title":"Clinical and Molecular Hepatology"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.3904\/kjim.2017.343","article-title":"Non\u2010Alcoholic Fatty Liver Disease and Lifestyle Modifications, Focusing on Physical Activity","volume":"33","author":"Kwak M. S.","year":"2018","journal-title":"Korean Journal of Internal Medicine"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1002\/hep.31158","article-title":"Inadequate Physical Activity and Sedentary Behavior Are Independent Predictors of Nonalcoholic Fatty Liver Disease","volume":"72","author":"Kim D.","year":"2020","journal-title":"Hepatology"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"e1438","DOI":"10.1016\/j.cgh.2021.06.029","article-title":"Physical Activity Is Associated With Nonalcoholic Fatty Liver Disease and Significant Fibrosis Measured by FibroScan","volume":"20","author":"Kim D.","year":"2022","journal-title":"Clinical Gastroenterology and Hepatology"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","DOI":"10.1186\/1479-5868-10-126","article-title":"Adult Self\u2010Reported and Objectively Monitored Physical Activity and Sedentary Behavior: NHANES 2005\u20102006","volume":"10","author":"Schuna J. M.","year":"2013","journal-title":"International Journal of Behavioral Nutrition and Physical Activity"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1249\/mss.0b013e31815a51b3","article-title":"Physical Activity in the United States Measured by Accelerometer","volume":"40","author":"Troiano R. P.","year":"2008","journal-title":"Medicine and Science in Sports and Exercise"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1136\/bjsm.37.3.197","article-title":"Limits to the Measurement of Habitual Physical Activity by Questionnaires","volume":"37","author":"Shephard R. 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The HUNT Study","volume":"62","author":"Croci I.","year":"2019","journal-title":"Progress in Cardiovascular Diseases"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1001\/jama.2018.14854","article-title":"The Physical Activity Guidelines for Americans","volume":"320","author":"Piercy K. L.","year":"2018","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1249\/MSS.0000000000000885","article-title":"Association Between Objectively Measured Physical Activity and Mortality in NHANES","volume":"48","author":"Fishman E. I.","year":"2016","journal-title":"Medicine and Science in Sports and Exercise"},{"key":"e_1_2_11_21_1","first-page":"454","article-title":"Physical Activity in U.S.: Adults Compliance With the Physical Activity Guidelines for Americans","volume":"40","author":"Tucker J. 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H.","year":"2010","journal-title":"Digestive and Liver Disease"},{"key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1038\/ajg.2014.155","article-title":"Development, External Validation, and Comparative Assessment of a New Diagnostic Score for Hepatic Steatosis","volume":"109","author":"Meffert P. J.","year":"2014","journal-title":"American Journal of Gastroenterology"},{"key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1002\/hep.30226","article-title":"Effect of Alcohol Consumption on Survival in Nonalcoholic Fatty Liver Disease: A National Prospective Cohort Study","volume":"70","author":"Hajifathalian K.","year":"2019","journal-title":"Hepatology"},{"key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/apt.13012","article-title":"Fatty Liver Indices in the Multiethnic United States National Health and Nutrition Examination Survey","volume":"41","author":"Ruhl C. 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