Lifestyle adherence and health behaviours in patients with metabolic dysfunction-associated steatotic liver disease: a cross-sectional study

Abstract Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing in prevalence and is the leading cause of hepatic fibrosis and cirrhosis in the industrialised world. Despite growing evidence for lifestyle interventions, adherence to nutritional and physical activity recommendations and psychological behaviours among patients with MASLD has not been previously characterised in Canada. We conducted a cross-sectional analysis of baseline data from patients with MASLD. Lifestyle adherence, including dietary patterns, physical activity and psychological measures, was assessed at a single time point to describe prevalence and patterns among participants. Adults with MASLD and advanced fibrosis were older (median age 58·4 v. 45·3 years; P < 0·001), had a greater BMI (median 36·3 v. 31·2; P < 0·001) and have higher presence of metabolic risk factors including type 2 diabetes mellitus ( P < 0·001), hypertension ( P = 0·001), thyroid disease ( P = 0·02) and were of White ethnicity ( P = 0·002). The prevalence of mood disorder was 31 % for anxiety and 16 % for depressive symptoms based on HADS-A and HADS-D ≥ 8 indicating borderline/abnormal anxiety and depression, respectively. Twenty per cent of patients had a Binge Eating Score ≥ 18 indicating moderate/severe binge eating behaviour. Most had poor adherence to a Mediterranean diet with the energy-restricted Mediterranean Diet Adherence Screener (er-MEDAS) ≤ 7 (56 % with poor adherence, 34 % with moderate adherence), 42 % reported weekly alcohol consumption and one-third had low self-reported activity levels on the International Physical Activity Questionnaire Short Form (IPAQ-SF). Here, we identified barriers to risk reduction in patients with MASLD, including increased prevalence of anxiety and depressive symptoms, high frequency of binge eating behaviours, poor adherence to Mediterranean diet quality and sedentary self-reported activity levels.