Abstract
BACKGROUND: Evidence regarding the effect of physical activity (PA) on the risk of cardiovascular disease (CVD) among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is scarce. We aimed to clarify the role of PA in preventing CVD in patients with MASLD and provide insights into PA recommendations specific to this patient group. METHODS: This study conducted two cohort studies of 112,872 subjects with MASLD using questionnaire-measured PA data and 22,426 subjects with MASLD using accelerometer-measured PA data. Incident CVD was ascertained from linked hospital and death records. Cox proportional hazard regression was used to investigate the associations. RESULTS: In the questionnaire-based cohort, performing more leisure-time PA and housework-related activity was associated with lower CVD risk in patients with MASLD. In the accelerometer-based cohort, total PA showed a linear inverse association with CVD risk, whereas a non-linear dose-response relationship was detected for moderate-intensity PA (MPA), vigorous-intensity PA (VPA) and moderate-to-vigorous-intensity PA (MVPA). Compared to inactive patients, those performing 150-300 min/week of MPA (HR 0.73, 95% CI 0.63-0.84) and >75 min/week of VPA (HR 0.70, 95% CI 0.55-0.89) were at lower CVD risk. Achieving 600 MET-min/week of MVPA in both weekend warrior and regularly active patterns showed similar cardiovascular benefits. Performing MPA beyond PA guidelines was associated with a further CVD risk reduction among patients with MASLD. CONCLUSIONS: Our findings broadly support the effect of current PA guidelines in preventing CVD events among subjects with MASLD and suggest that the recommendation of MPA could be even more ambitious for the population.