{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:29:43Z","timestamp":1788211783937,"version":"build-2803163510"},"reference-count":83,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T00:00:00Z","timestamp":1668470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Competitive State Research Financing of the Expert Responsibility area of Sein\u00e4joki Central Hospital","award":["VTR 5300\/3116"],"award-info":[{"award-number":["VTR 5300\/3116"]}]},{"name":"University of Tampere","award":["VTR 5300\/3116"],"award-info":[{"award-number":["VTR 5300\/3116"]}]},{"name":"the Finnish Foundation for the Promotion of Laboratory Medicine","award":["VTR 5300\/3116"],"award-info":[{"award-number":["VTR 5300\/3116"]}]},{"name":"Finnish Foundation of Clinical Chemistry","award":["VTR 5300\/3116"],"award-info":[{"award-number":["VTR 5300\/3116"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Sedentary lifestyle and excessive alcohol drinking are major modifiable risk factors of health. In order to shed further light on the relationships between physical activity and health consequences of alcohol intake, we measured biomarkers of liver function, inflammation, lipid status and fatty liver index tests in a large population-based sample of individuals with different levels of physical activity, alcohol drinking and other lifestyle risk factors. The study included 21,050 adult participants (9940 men, 11,110 women) (mean age 48.2 \u00b1 13.3 years) of the National FINRISK Study. Data on physical activity, alcohol drinking, smoking and body weight were recorded. The participants were classified to subgroups according to gender, levels of physical activity (sedentary, low, moderate, vigorous, extreme), alcohol drinking levels (abstainers, moderate drinkers, heavy drinkers) and patterns (regular or binge, types of beverages preferred in consumption). Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques. Physical activity was linearly and inversely related with the amount of alcohol consumption, with the lowest alcohol drinking levels being observed in those with vigorous or extreme activity (p &lt; 0.0005). Physically active individuals were less frequently binge-type drinkers, cigarette smokers or heavy coffee drinkers than those with sedentary activity (p &lt; 0.0005 for linear trend in all comparisons). In the General Linear Model to assess the main and interaction effects of physical activity and alcohol consumption on biomarker status, as adjusted for anthropometric measures, smoking and coffee consumption, increasing levels of physical activity were found to be associated with more favorable findings on serum GGT (p &lt; 0.0005), ALT (p &lt; 0.0005 for men), cholesterol (p = 0.025 for men; p &lt; 0.0005 for women), HDL-cholesterol (p &lt; 0.0005 for men, p = 0.001 for women), LDL-cholesterol (p &lt; 0.03 for men), triglycerides (p &lt; 0.0005 for men, p &lt; 0.03 for women), CRP (p &lt; 0.0005 for men, p = 0.006 for women) and fatty liver index (p &lt; 0.0005). The data support the view that regular moderate to vigorous physical activity may counteract adverse metabolic consequences of alcohol consumption on liver function, inflammation and lipid status. The role of physical activity should be further emphasized in interventions aimed at reducing health problems related to unfavorable risk factors of lifestyle.<\/jats:p>","DOI":"10.3390\/ijerph192215048","type":"journal-article","created":{"date-parts":[[2022,11,16]],"date-time":"2022-11-16T02:27:34Z","timestamp":1668565654000},"page":"15048","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of Physical Activity on the Characteristics and Metabolic Consequences of Alcohol Consumption: A Cross-Sectional Population-Based Study"],"prefix":"10.3390","volume":"19","author":[{"given":"Onni","family":"Niemel\u00e4","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Medical Research Unit, Sein\u00e4joki Central Hospital and Tampere University, 60220 Sein\u00e4joki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aini","family":"Bloigu","sequence":"additional","affiliation":[{"name":"Center for Life Course Health Research, University of Oulu, 90570 Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risto","family":"Bloigu","sequence":"additional","affiliation":[{"name":"Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90570 Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anni S.","family":"Halkola","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Medical Research Unit, Sein\u00e4joki Central Hospital and Tampere University, 60220 Sein\u00e4joki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Niemel\u00e4","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Medical Research Unit, Sein\u00e4joki Central Hospital and Tampere University, 60220 Sein\u00e4joki, Finland"},{"name":"Department of Anesthesiology, Oulu University Hospital, 90220 Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauri","family":"Aalto","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sein\u00e4joki Central Hospital and Tampere University, 33100 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiina","family":"Laatikainen","sequence":"additional","affiliation":[{"name":"Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland"},{"name":"Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland"},{"name":"Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s10654-013-9796-9","article-title":"Healthy lifestyle behaviors and decreased risk of mortality in a large prospective study of U.S. women and men","volume":"28","author":"Behrens","year":"2013","journal-title":"Eur. J. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1161\/CIRCULATIONAHA.117.032047","article-title":"Impact of healthy lifestyle factors on life expectancies in the US population","volume":"138","author":"Li","year":"2018","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1016\/S0140-6736(12)61766-8","article-title":"A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990\u20132010: A systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Lim","year":"2012","journal-title":"Lancet"},{"key":"ref_4","first-page":"k4168","article-title":"Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: Cohort study of 306 473 UK Biobank participants","volume":"363","author":"Larsson","year":"2018","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Nivukoski, U., Niemel\u00e4, M., Bloigu, A., Bloigu, R., Aalto, M., Laatikainen, T., and Niemel\u00e4, O. (2019). Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0218463"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1377\/hlthaff.21.2.78","article-title":"The case for more active policy attention to health promotion","volume":"21","author":"McGinnis","year":"2002","journal-title":"Health Affairs"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.ypmed.2009.02.017","article-title":"Healthy lifestyle and preventable death: Findings from the Japan Collaborative Cohort (JACC) study","volume":"48","author":"Tamakoshi","year":"2009","journal-title":"Prev. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1136\/bjsports-2016-096026","article-title":"Physical activity: What is already being done and how we can avert 1 million deaths annually in future","volume":"50","author":"Sundberg","year":"2016","journal-title":"Br. J. Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.cjca.2016.01.024","article-title":"Reflections on physical activity and health: What should we recommend?","volume":"32","author":"Warburton","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Liu, D., Han, S., and Zhou, C. (2022). The influence of physical exercise frequency and intensity on individual entrepreneurial behavior: Evidence from China. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912383"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.cca.2010.02.069","article-title":"Effect of exercise training on chronic inflammation","volume":"411","author":"Beavers","year":"2010","journal-title":"Clin. Chim. Acta"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.3389\/fphys.2019.01550","article-title":"Inflammatory effects of high and moderate intensity exercise-A systematic review","volume":"10","author":"Cerqueira","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.jacc.2015.11.034","article-title":"Exercise at the extremes: The amount of exercise to reduce cardiovascular events","volume":"67","author":"Eijsvogels","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","first-page":"7186137","article-title":"Plasma cytokine profiles in long-term strenuous exercise","volume":"2016","author":"Nielsen","year":"2016","journal-title":"J. Sports Med. (Hindawi. Publ. Corp.)"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jshs.2018.09.009","article-title":"The compelling link between physical activity and the body\u2019s defense system","volume":"8","author":"Nieman","year":"2019","journal-title":"J. Sport Health Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.jacc.2014.11.023","article-title":"Dose of jogging and long-term mortality: The Copenhagen City Heart Study","volume":"65","author":"Schnohr","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1002\/hep.22109","article-title":"Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease","volume":"47","author":"Kim","year":"2008","journal-title":"Hepatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/apt.13067","article-title":"The combined effects of alcohol consumption and body mass index on hepatic steatosis in a general population sample of European men and women","volume":"41","author":"Lau","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Niemel\u00e4, O., Niemel\u00e4, M., Bloigu, R., Aalto, M., and Laatikainen, T. (2017). Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers?. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0188574"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1053\/j.gastro.2008.10.052","article-title":"Elevated serum alanine aminotransferase and gamma-glutamyltransferase and mortality in the United States population","volume":"136","author":"Ruhl","year":"2009","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jhep.2022.02.021","article-title":"Development and validation of a model to predict incident chronic liver disease in the general population: The CLivD score","volume":"77","author":"Luukkonen","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1002\/hep.22090","article-title":"Serum aminotransferase activity and mortality risk in a United States community","volume":"47","author":"Lee","year":"2008","journal-title":"Hepatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2130","DOI":"10.1161\/CIRCULATIONAHA.105.552547","article-title":"Gamma-glutamyltransferase as a risk factor for cardiovascular disease mortality: An epidemiological investigation in a cohort of 163,944 Austrian adults","volume":"112","author":"Ruttmann","year":"2005","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"696-i","DOI":"10.1093\/ije\/dyx239","article-title":"Cohort Profile: The National FINRISK Study","volume":"47","author":"Borodulin","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"WHO MONICA Project Principal Investigators (1988). The World Health Organization MONICA Project (Monitoring trends and determinants in cardiovascular disease): A major international collaboration. J Clin Epidemiol., 41, 105\u2013114.","DOI":"10.1016\/0895-4356(88)90084-4"},{"key":"ref_27","unstructured":"Luepker, R.V., Evans, A., McKeigue, P., and Srinath Reddy, K. (2004). Cardiovascular Survey Methods, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/42569."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.alcohol.2019.03.001","article-title":"Liver enzymes in alcohol consumers with or without binge drinking","volume":"78","author":"Nivukoski","year":"2019","journal-title":"Alcohol"},{"key":"ref_29","unstructured":"Alcohol Research: Current Reviews Editorial Staff (2018). Drinking patterns and their definitions. Alcohol Res., 39, 17\u201318."},{"key":"ref_30","unstructured":"National Institute of Alcohol Abuse and Alcoholism (2004). NIAAA Council Approves Definition of Binge Drinking. NIAAA Newsl., 3, 3. Available online: https:\/\/pubs.niaaa.nih.gov\/publications\/Newsletter\/winter2004\/Newsletter_Number3.pdf."},{"key":"ref_31","unstructured":"World Health Organization (2000). International Guide for Monitoring Alcohol Consumption and Related Harm, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/66529."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., and Tiribelli, C. (2006). The Fatty Liver Index: A simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol., 6.","DOI":"10.1186\/1471-230X-6-33"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Nivukoski, U., Niemel\u00e4, M., Bloigu, A., Bloigu, R., Aalto, M., Laatikainen, T., and Niemel\u00e4, O. (2020). Combined effects of lifestyle risk factors on fatty liver index. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01270-7"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"i3857","DOI":"10.1136\/bmj.i3857","article-title":"Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: Systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013","volume":"354","author":"Kyu","year":"2016","journal-title":"BMJ"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jhep.2017.05.016","article-title":"Treatment of NAFLD with diet, physical activity and exercise","volume":"67","author":"Trenell","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.1007\/s00125-016-4079-0","article-title":"Physical activity and incident type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of prospective cohort studies","volume":"59","author":"Smith","year":"2016","journal-title":"Diabetologia"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Deguchi, N., Kojima, N., Osuka, Y., and Sasai, H. (2022). Factors associated with passive sedentary behavior among community-dwelling older women with and without knee osteoarthritis: The Otassha Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192113765"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"587557","DOI":"10.3389\/fpsyt.2020.587557","article-title":"Beneficial effects of exercise on depression and anxiety during the Covid-19 pandemic: A narrative review","volume":"11","author":"Hu","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/S0140-6736(15)00122-1","article-title":"Alcohol use disorders","volume":"387","author":"Connor","year":"2016","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.amepre.2022.03.021","article-title":"Binge drinking and alcohol problems among moderate average-level drinkers","volume":"63","author":"Holahan","year":"2022","journal-title":"Am. J. Prev. Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Niemel\u00e4, O., Aalto, M., Bloigu, A., Bloigu, R., Halkola, A.S., and Laatikainen, T. (2022). Alcohol drinking patterns and laboratory indices of health: Does type of alcohol preferred make a difference?. Nutrients, 14.","DOI":"10.3390\/nu14214529"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1111\/j.1464-5491.2006.01897.x","article-title":"Association of leisure time physical activity and abdominal obesity with fasting serum insulin and 2-h postchallenge plasma glucose levels","volume":"23","author":"Borodulin","year":"2006","journal-title":"Diabet. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1002\/hep.27544","article-title":"Moderate to vigorous physical activity volume is an important factor for managing nonalcoholic fatty liver disease: A retrospective study","volume":"61","author":"Oh","year":"2015","journal-title":"Hepatology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.mayocp.2018.10.029","article-title":"Comparative relevance of physical fitness and adiposity on life expectancy: A UK Biobank observational study","volume":"94","author":"Zaccardi","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"160","DOI":"10.3389\/fpsyt.2017.00160","article-title":"More reasons to move: Exercise in the treatment of alcohol use disorders","volume":"8","author":"Hallgren","year":"2017","journal-title":"Front. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1093\/aje\/kwi125","article-title":"The associations of physical activity and adiposity with alanine aminotransferase and gamma-glutamyltransferase","volume":"161","author":"Lawlor","year":"2005","journal-title":"Am. J. Epidemiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1136\/bjsports-2016-096194","article-title":"Does physical activity moderate the association between alcohol drinking and all-cause, cancer and cardiovascular diseases mortality? A pooled analysis of eight British population cohorts","volume":"51","author":"Perreault","year":"2017","journal-title":"Br. J. Sports Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e000594","DOI":"10.1161\/JAHA.113.000594","article-title":"Association of physical activity in childhood and early adulthood with carotid artery elasticity 21 years later: The cardiovascular risk in Young Finns Study","volume":"3","author":"Pahkala","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/S0016-5085(98)70599-2","article-title":"Steatohepatitis: A tale of two \u201chits\u201d?","volume":"114","author":"Day","year":"1998","journal-title":"Gastroenterology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"k2817","DOI":"10.1136\/bmj.k2817","article-title":"Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: Observational study","volume":"362","author":"Tapper","year":"2018","journal-title":"BMJ"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1002\/hep.22727","article-title":"Synergism between smoking and alcohol consumption with respect to serum gamma-glutamyltransferase","volume":"49","author":"Breitling","year":"2009","journal-title":"Hepatology"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Park, E.Y., Lim, M.K., Oh, J.K., Cho, H., Bae, M.J., Yun, E.H., Kim, D.I., and Shin, H.R. (2013). Independent and supra-additive effects of alcohol consumption, cigarette smoking, and metabolic syndrome on the elevation of serum liver enzyme levels. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0063439"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Zheng, J.S., Sharp, S.J., Imamura, F., Koulman, A., Schulze, M.B., Ye, Z., Griffin, J., Guevara, M., Huerta, J.M., and Kr\u00f6ger, J. (2017). Association between plasma phospholipid saturated fatty acids and metabolic markers of lipid, hepatic, inflammation and glycaemic pathways in eight European countries: A cross-sectional analysis in the EPIC-InterAct study. BMC Med., 15.","DOI":"10.1186\/s12916-017-0968-4"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Li, K., H\u00fcsing, A., and Kaaks, R. (2014). Lifestyle risk factors and residual life expectancy at age 40: A German cohort study. BMC Med., 12.","DOI":"10.1186\/1741-7015-12-59"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Manuel, D.G., Perez, R., Sanmartin, C., Taljaard, M., Hennessy, D., Wilson, K., Tanuseputro, P., Manson, H., Bennett, C., and Tuna, M. (2016). Measuring burden of unhealthy behaviours using a multivariable predictive approach: Life expectancy lost in Canada attributable to smoking, alcohol, physical inactivity, and diet. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002082"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1111\/joim.12802","article-title":"A randomized clinical trial of the effectiveness of a Web-based health behaviour change support system and group lifestyle counselling on body weight loss in overweight and obese subjects: 2-year outcomes","volume":"284","author":"Teeriniemi","year":"2018","journal-title":"J. Intern. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1373\/clinchem.2006.081620","article-title":"Gamma glutamyltransferase and long-term survival: Is it just the liver?","volume":"53","author":"Endler","year":"2007","journal-title":"Clin. Chem."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Niemel\u00e4, O. (2016). Biomarker-based approaches for assessing alcohol use disorders. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13020166"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1002\/hep.25555","article-title":"Fatty liver index, gamma-glutamyltransferase, and early carotid plaques","volume":"55","author":"Kozakova","year":"2012","journal-title":"Hepatology"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Mascar\u00f3, C.M., Bouzas, C., Montemayor, S., Garc\u00eda, S., Mateos, D., Casares, M., G\u00f3mez, C., Ugarriza, L., Borr\u00e0s, P.A., and Martinez, J.A. (2022). Impact of physical activity differences due to COVID-19 pandemic lockdown on non-alcoholic fatty liver parameters in adults with metabolic syndrome. Nutrients, 14.","DOI":"10.3390\/nu14122370"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1093\/annonc\/mds337","article-title":"Light alcohol drinking and cancer: A meta-analysis","volume":"24","author":"Bagnardi","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"h4238","DOI":"10.1136\/bmj.h4238","article-title":"Light to moderate intake of alcohol, drinking patterns, and risk of cancer: Results from two prospective US cohort studies","volume":"351","author":"Cao","year":"2015","journal-title":"BMJ"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"474","DOI":"10.4143\/crt.2017.094","article-title":"Light alcohol drinking and risk of cancer: A meta-analysis of cohort studies","volume":"50","author":"Choi","year":"2018","journal-title":"Cancer Res. Treat."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e124","DOI":"10.1016\/S2468-2667(18)30022-7","article-title":"Contribution of alcohol use disorders to the burden of dementia in France 2008\u20132013: A nationwide retrospective cohort study","volume":"3","author":"Schwarzinger","year":"2018","journal-title":"Lancet Public Health"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"j2353","DOI":"10.1136\/bmj.j2353","article-title":"Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: Longitudinal cohort study","volume":"357","author":"Topiwala","year":"2017","journal-title":"BMJ"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1161\/HYPERTENSIONAHA.116.08145","article-title":"Moderate alcohol consumption is associated with left ventricular diastolic dysfunction in nonalcoholic hypertensive patients","volume":"68","author":"Catena","year":"2016","journal-title":"Hypertension"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/joim.12390","article-title":"Alcohol and cardiovascular diseases: Where do we stand today?","volume":"278","author":"Klatsky","year":"2015","journal-title":"J. Intern. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e004060","DOI":"10.1161\/JAHA.116.004060","article-title":"Alcohol consumption, left atrial diameter, and atrial fibrillation","volume":"5","author":"McManus","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/add.13152","article-title":"Drinking and mortality: Long-term follow-up of drinking-discordant twin pairs","volume":"111","author":"Rose","year":"2016","journal-title":"Addiction"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(18)30134-X","article-title":"Risk thresholds for alcohol consumption: Combined analysis of individual-participant data for 599,912 current drinkers in 83 prospective studies","volume":"391","author":"Wood","year":"2018","journal-title":"Lancet"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1016\/j.jacc.2009.09.009","article-title":"Inflammation in atherosclerosis: From pathophysiology to practice","volume":"54","author":"Libby","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"4849","DOI":"10.21037\/jtd.2017.10.155","article-title":"Serum high density lipoprotein cholesterol level and risk of death: Let\u2019s avoid the extremes","volume":"9","author":"Moradi","year":"2017","journal-title":"J. Thorac. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1056\/NEJMoa1707914","article-title":"Anti-inflammatory therapy with canakinumab for atherosclerotic disease","volume":"377","author":"Ridker","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1373\/clinchem.2017.273243","article-title":"C-reactive protein and cardiovascular risk: Will the controversy end after CANTOS?","volume":"63","author":"Koenig","year":"2017","journal-title":"Clin. Chem."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"754","DOI":"10.3389\/fimmu.2018.00754","article-title":"Role of C-reactive protein at sites of inflammation and infection","volume":"9","author":"Sproston","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/apt.14157","article-title":"Systematic review: Exercise-induced gastrointestinal syndrome-implications for health and intestinal disease","volume":"46","author":"Costa","year":"2017","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1038\/s41577-019-0177-9","article-title":"Can physical activity ameliorate immunosenescence and thereby reduce age-related multi-morbidity?","volume":"19","author":"Duggal","year":"2019","journal-title":"Nat. Rev. Immunol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40798-016-0045-0","article-title":"Acute changes in inflammatory biomarker levels in recreational runners participating in a marathon or half-marathon","volume":"2","author":"Kangastupa","year":"2016","journal-title":"Sports Med. Open"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1152\/japplphysiol.00622.2016","article-title":"Recovery of the immune system after exercise","volume":"122","author":"Peake","year":"2017","journal-title":"J. Appl. Physiol"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.3389\/fimmu.2018.02187","article-title":"Effects of acute and chronic exercise on immunological parameters in the elderly aged: Can physical activity counteract the effects of aging?","volume":"9","author":"Sellami","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1136\/bjsports-2022-105733","article-title":"Physical activity and risk of infection, severity and mortality of COVID-19: A systematic review and non-linear dose-response meta-analysis of data from 1,853,610 adults","volume":"56","author":"Ezzatvar","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1016\/S0140-6736(15)60461-5","article-title":"A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial","volume":"385","author":"Ngandu","year":"2015","journal-title":"Lancet (London, England)"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1001\/jamaneurol.2022.2672","article-title":"Association of daily step count and intensity with incident dementia in 78 430 adults living in the UK","volume":"79","author":"Ahmadi","year":"2022","journal-title":"JAMA Neurol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/22\/15048\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:18:57Z","timestamp":1760145537000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/22\/15048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,15]]},"references-count":83,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192215048"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192215048","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,15]]}}}