Correlation of Physical Activity and Sleep Quality with Metabolic-Associated Fatty Liver Disease in Community-Based Older Adults

Abstract Purpose: Physical inactivity has been identified as a potential risk factor for metabolic-associated fatty liver disease (MAFLD) in the elderly. However, the specific effects of different types and intensities of physical activity on MAFLD risk remain unclear. This study aims to examine the correlation between the type and level of physical activity and the prevalence of MAFLD in an elderly community-based population. Methods: A cross-sectional study was conducted among 815 older adults aged 65 years and above. Participants' demographic and anthropometric data were collected through field assessments and questionnaires. Body composition was measured using InBody720 (Biospace, Korea), while fatty liver diagnosis was performed via ultrasound, and liver fat content and elasticity were assessed using FibroScan. Physical activity levels were evaluated using the Physical Activity Scale for the Elderly (PASE). Binary logistic regression models were employed to analyze the relationship between various types and intensities of physical activity and MAFLD prevalence. Results: Among the 815 participants, 396 were diagnosed with MAFLD. After adjusting for confounding variables, higher levels of total physical activity (OR: 0.99, 95% CI: 0.98–0.99, P < 0.001), leisure-related physical activity (OR: 0.98, 95% CI: 0.98–0.98, P < 0.001), and occupational-related physical activity (OR: 0.99, 95% CI: 0.98–0.99, P < 0.001) were significantly associated with a lower risk of MAFLD. In contrast, home-related physical activity (OR: 0.99, 95% CI: 0.98–0.99, P = 0.103) showed no significant association.When total physical activity was categorized into four levels—light (LPA), moderate (MPA), moderate-to-vigorous (MVPA), and vigorous (VPA)—MPA was not significantly associated with MAFLD risk (OR: 0.71, 95% CI: 0.38–1.32). However, MVPA (OR: 0.24, 95% CI: 0.14–1.41) and VPA (OR: 0.05, 95% CI: 0.03–0.09) exhibited strong negative associations with MAFLD risk. Specifically, moderate-intensity leisure physical activity (LeisurePA-MPA) was significantly associated with a reduced risk of MAFLD (OR: 0.42, 95% CI: 0.21–0.87, P < 0.05), as were moderate-to-vigorous (LeisurePA-MVPA, OR: 0.24, 95% CI: 0.11–0.50, P < 0.001) and vigorous (LeisurePA-VPA, OR: 0.07, 95% CI: 0.03–0.15, P < 0.001) leisure activities. Additionally, only vigorous-intensity occupational physical activity (Occupation-VPA) was significantly associated with a reduced risk of MAFLD (OR: 0.47, 95% CI: 0.28–0.77, P < 0.001). Conclusion: Higher levels of total, leisure-related, and occupational-related physical activity are significantly associated with a lower risk of MAFLD in older adults, whereas home-related physical activity shows no significant effect. In terms of activity intensity, MVPA and VPA demonstrate strong protective effects against MAFLD, particularly in leisure and occupational settings. These findings suggest that older adults should engage in moderate-to-vigorous intensity leisure and occupational activities to effectively reduce MAFLD risk.