{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T19:12:51Z","timestamp":1771355571957,"version":"3.50.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Pudong New Area Health Commission","award":["2025-PWXZ-05"],"award-info":[{"award-number":["2025-PWXZ-05"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metabolic-associated fatty liver disease (MAFLD), a disease closely associated with metabolic abnormalities (e.g., insulin resistance, dyslipidemia, elevated blood glucose, and obesity), has become a global public health challenge. This study explored the independent associations between sedentary behavior and depressive symptoms with MAFLD and analyzed the potential interactions between these two factors and the risk of MAFLD occurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study is based on data from two cycles of the National Health and Nutrition Examination Survey (NHANES) from 2017\u2009~\u20092020 and 2021\u2009~\u20092023 and analyzes the relationships among depressive symptoms, sedentary behavior, potential confounding factors, and MAFLD. A multivariate logistic regression model was used in the present study, and different subgroups of sedentary behavior were analyzed to assess the associations among sedentary behavior, depression and MAFLD. In addition, the presence of additive interactions among these variables was assessed by calculating the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 10,612 participants were included in this study (weighted sample size of 183,231,593), of whom 4,501 (weighted proportion of 42%) had MAFLD. Compared with participants with less daily sedentary time, those with more sedentary time had a greater risk of MAFLD (OR = 1.33, 95% CI: 1.08\u2009~\u20091.64). We also found that, compared with individuals without depressive symptoms, individuals with depressive symptoms were significantly associated with an increased risk of MAFLD (OR = 1.26, 95% CI: 1.03\u2009~\u20091.54). Furthermore, sedentary behavior significantly interacted with depression in overweight individuals, affecting the risk of MAFLD (relative excess risk (RERI) = 0.684, 95% CI: 0.312\u2009~\u20091.057; attributable proportion (AP) = 0.360, 95% CI: 0.323\u2009~\u20090.397; synergy index (S) = 1.623, 95% CI: 1.177\u2009~\u20092.070). Poisson regression with 90% CI confirmed this interaction (RERI\u2009=\u20090.318, 90% CI: 0.036\u2009~\u20090.600; AP\u2009=\u20090.223, 90% CI: 0.182\u2009~\u20090.263; S=1.310, 90% CI: 1.000\u2009~\u20091.620).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sedentary behavior and depression have a significant synergistic effect on MAFLD in overweight individuals. Therefore, improving individuals\u2019 psychological health status and reducing sedentary time may have positive effects on the prevention and treatment of MAFLD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0342336","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:24:57Z","timestamp":1771352697000},"page":"e0342336","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interaction effects of sedentary behavior and depression on MAFLD in NHANES 2017\u20132020 and 2021\u20132023"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7491-4837","authenticated-orcid":true,"given":"Wuqian","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yujing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qunyou","family":"Cong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoshun","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhe","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhirong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"issue":"5","key":"pone.0342336.ref001","doi-asserted-by":"crossref","first-page":"696","DOI":"10.21037\/hbsn-21-269","article-title":"Metabolic associated fatty liver disease (MAFLD): a milestone in the history of fatty liver disease","volume":"10","author":"J Alharthi","year":"2021","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"9","key":"pone.0342336.ref002","doi-asserted-by":"crossref","first-page":"2691","DOI":"10.1210\/clinem\/dgac321","article-title":"Global Prevalence and Clinical Characteristics of Metabolic-associated Fatty Liver Disease: A Meta-Analysis and Systematic Review of 10 739 607 Individuals","volume":"107","author":"KE Chan","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"pone.0342336.ref003","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1007\/s12072-020-10094-2","article-title":"The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease","volume":"14","author":"M Eslam","year":"2020","journal-title":"Hepatol Int"},{"key":"pone.0342336.ref004","doi-asserted-by":"crossref","first-page":"101238","DOI":"10.1016\/j.molmet.2021.101238","article-title":"Metabolic-associated fatty liver disease and lipoprotein metabolism","volume":"50","author":"J Heeren","year":"2021","journal-title":"Mol Metab"},{"key":"pone.0342336.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev-clinpsy-050817-084811","article-title":"Risk Factors for Depression: An Autobiographical Review","volume":"14","author":"C Hammen","year":"2018","journal-title":"Annu Rev Clin Psychol"},{"key":"pone.0342336.ref006","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.jad.2023.04.093","article-title":"Associations of depression score with metabolic dysfunction-associated fatty liver disease and liver fibrosis","volume":"334","author":"H Cai","year":"2023","journal-title":"J Affect Disord"},{"issue":"4","key":"pone.0342336.ref007","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/JES.0b013e3181877d1a","article-title":"The evolving definition of \u201csedentary\u201d","volume":"36","author":"RR Pate","year":"2008","journal-title":"Exerc Sport Sci Rev"},{"key":"pone.0342336.ref008","unstructured":"Adults\u2019 Sedentary Behavior - American Journal of Preventive Medicine. 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