Ioanna Panagiota Kalafati, Sara Beigrezaei, Evangelia Mentsiou-Nikolaou, Julieth Pilar Uriza-Pinzon, Caterina Buranelli, Carmen Dietvorst, Vivian de Jong, Lucia Lopez-Bermudo, Federico Rosato, Antonio Liguori, Luca Miele, Jorn M. Schattenberg, Manuel Romero-Gomez, Manuel Castro Cabezas, Jo Massoels, Diederick E. Grobbee, George V. Dedoussis, Oscar H. Franco, on behalf of the GRIPonMASH consortium.
1Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece. 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Submission contact: Tessa Vellema, t.vellema@franciscus.nl
Background: Lifestyle factors are key determinants of metabolic dysfunction-associated steatotic liver disease (MASLD). This multinational cohort examined associations between lifestyle factors, a composite lifestyle risk score (CLRS), controlled attenuation parameter (CAP), and liver stiffness measurement (LSM).
Methods: This cross-sectional analysis included 3,017 adults at increased MASLD risk across 10 European countries, screened by transient elastography (MASLD defined as CAP ≥ 280 dB/m). Sleep quality (PSQI), physical activity (IPAQ), and Mediterranean diet adherence (MEDAS) were combined into a CLRS and related to log-transformed CAP and LSM using multivariable regression adjusted for age, sex, BMI, and site.
Results: The sample was 51.4% female, mean age 59 (SD 14) years; MASLD was present in 42% and significant fibrosis (LSM > 8 kPa) in 8%. Sleep quality and sedentary behaviour were not associated with lnCAP or lnLSM. Higher MEDAS was inversely associated with lnCAP (β = -0.006, p = 0.002), including among participants with BMI ≥ 25 kg/m² (β = -0.006, p = 0.001). Moderate-to-vigorous physical activity was inversely associated with lnCAP (β = -0.00004, p = 0.04) and among those with BMI ≥ 25 kg/m² (β = -0.00004, p = 0.014). CLRS was positively associated with lnCAP (β = 0.009, p = 0.015) and among BMI ≥ 25 kg/m² participants (β = 0.01, p = 0.01); no significant associations were seen in normal-weight participants.
Discussion/Conclusion: A 1-point higher CLRS was associated with 0.9% higher CAP, particularly among participants with overweight or obesity (1%), supporting the relevance of combined lifestyle assessment in steatotic liver disease risk stratification.