{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:02:15Z","timestamp":1784732535649,"version":"3.55.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"the Open Fund of Key Laboratory of Hepatosplenic Surgery, Ministry of Education","award":["GPKF202304"],"award-info":[{"award-number":["GPKF202304"]}]},{"name":"Suzhou Clinical Center of Digestive Diseases","award":["Szlcyxzx202101"],"award-info":[{"award-number":["Szlcyxzx202101"]}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82000540"],"award-info":[{"award-number":["82000540"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Youth Program of Suzhou Health Committee","award":["KJXW2019001"],"award-info":[{"award-number":["KJXW2019001"]}]},{"name":"Suzhou Pilot Program of Basic Research","award":["SSD2024029"],"award-info":[{"award-number":["SSD2024029"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Med Res"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>There is limited prospective evidence on the association of physical activity with metabolic dysfunction\u2013associated steatotic liver disease. We aimed to use data from two major databases to systematically quantify the correlation of physical activity with the risk of metabolic dysfunction\u2013associated steatotic liver disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study used data from the National Health and Nutrition Examination Survey (2007\u20132020) and UK Biobank. Initially, a cross-sectional study was conducted using the data from the National Health and Nutrition Examination Survey data to assess the links between physical activity and metabolic dysfunction\u2013associated steatotic liver disease using weighted logistic regression analysis with appropriate sample weights to ensure national representativeness. Subsequently, Cox proportional hazards regression and restricted cubic splines models were applied to infer causality and evaluate the potential dose\u2013response relationships in the UK Biobank cohort over a median follow-up period of 14.18 years. Additionally, subgroup and sensitivity analyses were conducted to test the robustness of the results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the National Health and Nutrition Examination Survey, higher physical activity levels were inversely associated with metabolic dysfunction\u2013associated steatotic liver disease risk (odds ratio: 0.78, 95% confidence interval: 0.63\u20130.97). This finding was supported in the UK Biobank cohort (hazard ratio: 0.57, 95% confidence interval: 0.34\u20130.76). A nonlinear dose\u2013response relationship existed between physical activity and metabolic dysfunction\u2013associated steatotic liver disease (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.023 for a nonlinearity). Subgroup analyses highlighted stronger effects in overweight\/obese individuals (hazard ratio: 0.62, 95% confidence interval: 0.43\u20130.88), suggesting that this high-risk population may derive particular benefit from increased physical activity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Analyses of two large databases demonstrated a nonlinear dose\u2013response association between higher physical activity levels and reduced metabolic dysfunction\u2013associated steatotic liver disease risk. Moderate physical activity levels (600 to &lt;3000 metabolic equivalent of task\u2013min\/week) were significantly protective, and high physical activity levels (\u22653000 metabolic equivalent of task\u2013min\/week) conferred additional benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03000605261467633","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:35:14Z","timestamp":1784550914000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between physical activity and metabolic dysfunction\u2013associated steatotic liver disease: Evidence from the National Health and Nutrition Examination Survey and UK Biobank"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2816-7141","authenticated-orcid":false,"given":"Yiping","family":"Shen","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4817-4428","authenticated-orcid":false,"given":"Meiyu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxi","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihe","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengyi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0544-9248","authenticated-orcid":false,"given":"Jinzhou","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunfang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Soochow University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(22)00165-0"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.06.003"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000004"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.02.023"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000001636"},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24043394","article-title":"The impact of exercise on immunity, metabolism, and atherosclerosis","volume":"24","author":"Meyer-Lindemann U","year":"2023","unstructured":"Meyer-Lindemann U, Moggio A, Dutsch A, et al. The impact of exercise on immunity, metabolism, and atherosclerosis. Int J Mol Sci 2023; 24: 3394.","journal-title":"Int J Mol Sci"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000002800"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32207"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2024.102320"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-6-33"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.09.033"},{"key":"e_1_3_3_13_2","unstructured":"World Health Organization. Global Physical Activity Questionnaire (GPAQ) analysis guide https:\/\/www.who.int\/publications\/m\/item\/global-physical-activity-questionnaire (2021 accessed 7 April 2025)."},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1123\/jpah.6.6.790"},{"key":"e_1_3_3_15_2","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17197161","article-title":"Validity and reliability of international physical activity questionnaires for adults across EU countries: systematic review and meta analysis","volume":"17","author":"Sember V","year":"2020","unstructured":"Sember V, Meh K, Sori\u0107 M, et al. Validity and reliability of international physical activity questionnaires for adults across EU countries: systematic review and meta analysis. Int J Environ Res Public Health 2020; 17: 7161.","journal-title":"Int J Environ Res Public Health"},{"key":"e_1_3_3_16_2","unstructured":". IPAQ Research Committee. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ)-short and long forms https:\/\/sites.google.com\/view\/ipaq\/score (2005 accessed 7 April 2025)."},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-024-01568-9"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/sms.14636"},{"key":"e_1_3_3_19_2","article-title":"Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study","volume":"367","author":"Chen C","year":"2019","unstructured":"Chen C, Ye Y, Zhang Y, et al. Weight change across adulthood in relation to all cause and cause specific mortality: prospective cohort study. BMJ 2019; 367: l5584.","journal-title":"BMJ"},{"key":"e_1_3_3_20_2","unstructured":". National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES): questionnaires datasets and related documentation https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/ (2025 accessed 7 April 2025)."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-023-02030-z"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000066"},{"key":"e_1_3_3_23_2","unstructured":"Blane D Townsend P Phillimore P et al. Health and deprivation: inequality and the north. 1st ed. Abingdon: Routledge 1988."},{"key":"e_1_3_3_24_2","first-page":"816","article-title":"Association between diabetes and anemia: evidence from NHANES and the UK Biobank","volume":"48","author":"Wang D","year":"2025","unstructured":"Wang D, Morton JI, Salim A, et al. Association between diabetes and anemia: evidence from NHANES and the UK Biobank. Diabetes Care 2025; 48: 816\u2013826.","journal-title":"Diabetes Care"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-23568-5"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/69.1.239"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.04.031"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-2032"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.07.010"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0046819"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31018"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41430-021-00923-4"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2018.00588"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2024.1359476"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001288"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1080\/14728222.2021.2018418"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.08.023"}],"container-title":["Journal of International Medical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605261467633","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03000605261467633","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03000605261467633","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T14:17:17Z","timestamp":1784729837000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03000605261467633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":36,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/03000605261467633"],"URL":"https:\/\/doi.org\/10.1177\/03000605261467633","relation":{},"ISSN":["0300-0605","1473-2300"],"issn-type":[{"value":"0300-0605","type":"print"},{"value":"1473-2300","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"article-number":"03000605261467633"}}