Joint Association of Relative Grip Strength and Regular Exercise Participation with Nonalcoholic Fatty Liver Disease: A Prospective Cohort Study

Purpose: Our primary aim was to elucidate the joint association between relative grip strength (RGS) and regular exercise participation with non-alcoholic fatty liver disease (NAFLD) incidence, utilizing longitudinal data.Methods: A total of 1,702 participants in this study comprised general adults aged 51 to 88 years, who had engaged in the survey both in 2013 to 2018 and during the subsequent follow-up in 2019 to 2020.NAFLD were determined by using the hepatic steatosis index.RGS was determined using the JAMA-5030J1 equipment (SAEHAN).To validate the relationship between the interaction of RGS and regular exercise participation and its impact on risk of developing NAFLD, a proportional hazards Cox regression model was used.Subsequently, we computed the hazard ratio (HR) and 95% confidence interval (95% CI) for NAFLD.Results: In the non-regular exercise group, middle RGS and high RGS reduced the HR for NAFLD by 29% (HR, 0.71; 95% CI, 0.51-0.99)and 78% (HR, 0.22; 95% CI, 0.13-0.35),respectively, compared to low RGS.Significant associations were observed only between high RGS and HR for NAFLD in the regular exercise group (HR, 0.40; 95% CI, 0.22-0.72).Furthermore, in all subjects, both the high RGS/non-regular exercise and high RGS/regular exercise groups showed a respective 60% (HR, 0.40; 95% CI, 0.29-0.56)and 54% (HR, 0.44; 95% CI, 0.31-0.63)lower HR for NAFLD compared to the low RGS/non-regular exercise group. Conclusion:This study investigates that high level of RGS were independently associated with reducing risk of developing NAFLD.RGS is an important factor that can predict the risk of developing NAFLD, and regular exercise participation is essential for increasing RGS.