Researchers analysed data from 5,207. Physical activity was measured using accelerometers rather than self-reported questionnaires. MASLD was identified using the Hepatic Steatosis Index, with an alternative definition used in a sensitivity analysis.
Researchers also assessed estimated 10-year cardiovascular disease (CVD) and atherosclerotic cardiovascular disease risk using the Predicting Risk of Cardiovascular Disease Events equations. These risk estimates were cross-sectional, whereas the mortality analysis examined outcomes over time.
Over a median follow-up of 14.7 years, 584 deaths, including 198 from cardiovascular disease, occurred among 2,785 individuals with MASLD.
Higher MVPA was associated with a lower risk of all-cause mortality. After adjustment for demographic and clinical factors, individuals in the highest activity quartile had a 59% lower risk of death than those in the lowest quartile.
Researchers also observed an association between MVPA and cardiovascular mortality. Each standard deviation increase in MVPA was associated with a 49% lower risk of cardiovascular death after adjustment for waist circumference and other risk factors.
The relationship was nonlinear, with the greatest reduction in predicted mortality risk occurring at lower activity levels. Higher total physical activity was also associated with lower mortality, although the association was less pronounced than that observed for MVPA.
Sedentary behaviour was not significantly associated with all-cause or cardiovascular mortality after adjustment. Higher activity was also associated with a more favourable distribution of estimated 10-year cardiovascular risk categories.
Researchers concluded that higher MVPA was associated with lower cardiovascular mortality among individuals with MASLD, supporting efforts to promote physical activity as part of lifestyle management.
However, the observational design means that causation cannot be established. MASLD was defined using non-invasive indices rather than liver histology or imaging, and residual confounding could not be excluded. Physical activity may also have been underestimated because the accelerometers could not capture certain types of exercise.
Researchers called for further investigation into activity intensity and its relationship with cardiovascular outcomes in MASLD.
Reference:
Kim D et al. Impact of Physical Activity on Cardiovascular Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease. J Gastroenterol Hepatol. 2026. DOI; 10.1111/jgh.70826.
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