Following the "Eight Elements of Life (Three Good, Two No, Three Standards)" can reduce the risk of non-alcoholic fatty liver disease by 90% and serious liver disease by 60%.

Currently, nearly half of adults in China suffer from fatty liver disease. China's fatty liver crisis is imminent! Among them, non-alcoholic fatty liver disease (NAFLD) refers to fatty degeneration of at least 5% of hepatocytes in the liver, while excluding fatty liver damage caused by known damaging factors such as excessive drinking, viral infection or drugs. NAFLD is the most common chronic liver disease, affecting more than a quarter of the adult population worldwide. In addition to causing liver diseases such as cirrhosis, liver failure, and liver cancer, NAFLD also increases the risk of cardiovascular and cerebrovascular diseases and chronic kidney disease. However, there are currently no clinically approved drugs for the treatment and intervention of NAFLD. Therefore, it is crucial to explore effective and feasible measures to prevent NAFLD.

Recently, the American Heart Association (AHA) released eight cardiovascular health (CVH) indicators, namely "Life's Essential 8" (LE8), which include four healthy behaviors (stay away from tobacco, regular physical activity, healthy diet, healthy sleep) and four health factors (ideal body mass index, ideal blood pressure level, ideal blood sugar level, ideal blood lipid level). Although NAFLD and cardiovascular events have many common risk factors, the overall impact of the introduction and implementation of the LE8 concept on the burden of NAFLD in the general population has not yet been evaluated.

In response to the above clinical issues, the medical journal Metabolism recently published a research paper titled "A healthy lifestyle, Life's Essential 8 scores and new-onset severe NAFLD: a prospective analysis in UK Biobank"**. The study showed that following an ideal lifestyle can reduce the risk of NAFLD by 80%, while following the "Eight Essentials of Life" can reduce the risk of NAFLD by 90%. Professor Qin Xianhui of the National Clinical Research Center for Kidney Diseases of Nanfang Hospital is the corresponding author of the article, and Dr. He Panpan is the first author.

The study included more than 260,000 participants from the UK Biobank who had no liver disease at baseline. A healthy lifestyle includes six dimensions: maintaining a body mass index less than 25 kg/m2, not smoking, drinking in moderation, being physically active, sleeping 6-8 hours, and having a healthy diet. Following only 1 or 0 healthy lifestyles is defined as an unhealthy lifestyle, following 2-4 healthy lifestyles is a moderate lifestyle, and following 5 or more healthy lifestyles is an ideal lifestyle.

The score of the "Eight Elements of Life" is calculated based on the recommendations of the American Heart Association (AHA). Each indicator of the "Eight Elements of Life" is scored from 0 to 100, and the higher the score, the higher the degree of compliance. The specific standards are briefly described as follows:

1. Nicotine exposure: do not smoke, quit smoking, and stay away from secondhand smoke;

2. Exercise: Adults should do at least 150 minutes of moderate-intensity exercise (such as brisk walking) or 75 minutes of high-intensity exercise (such as running) per week.

3. Diet: Eat a healthy diet, eat more vegetables, fruits, dairy products, vegetable oils, fish and whole grains, eat less or no meat, refined grains, sugary drinks;

4. Sleep: The ideal sleep duration is 6-8 hours;

5. Weight: Maintain a body mass index of less than 25 kg/m2;

6. Blood pressure: systolic/diastolic pressure less than 120/80 mmHg;

7. Blood sugar: fasting blood sugar <5.6 mmol/L (or glycosylated hemoglobin <5.7%);

8. Blood lipids: non-high-density lipoprotein cholesterol <3.4mmol/L.

The total score of the "Eight Elements of Life" was the arithmetic mean of the individual scores. According to the recommendations, in this study, LE8 scores of 80-100 were classified as high CVH group, 60-79 as medium CVH group, and 0-59 as low CVH group.

The results show that:

1. Compared with participants with an unfavorable lifestyle, participants with a moderate or ideal lifestyle had a significantly reduced risk of NAFLD by 40% and 80%, respectively, and a significantly reduced risk of severe liver disease (cirrhosis, liver failure, liver cancer, and liver death) by 30% and 48%, respectively;

2. Compared with participants with low CVH, participants in the moderate or high CVH groups had a significantly lower risk of NAFLD by 57% and 90%, respectively, and a significantly lower risk of severe liver disease (cirrhosis, liver failure, liver cancer, and liver death) by 43% and 58%, respectively;

3. Similar negative correlations were observed in populations with different economic development levels and different genetic susceptibility;

4. Population attributable risk analysis found that, compared with unhealthy and moderate lifestyles, following an ideal lifestyle can prevent 66% of the risk of NAFLD; compared with low and moderate CVH, better adherence to the "Eight Elements of Life" (high CVH) can prevent 77% of the risk of NAFLD.

Figure 1. Association between healthy lifestyle, “eight elements of life” score and new-onset NAFLD

This study shows that lifestyle management is the cornerstone of NAFLD prevention and treatment. Adhering to a healthy lifestyle and improving LE8 scores may be feasible and effective strategies for preventing NAFLD. This study provides lifestyle recommendations for the primary prevention of NAFLD in people with different economic status and different genetic risks. In addition, it will also provide a basis for the subsequent formulation of relevant guidelines or policies for preventing NAFLD through lifestyle adjustments.

This study also reiterates that when we work tirelessly and tirelessly to pursue new risk factors and new treatment strategies for metabolic diseases, we should always adhere to a healthy lifestyle as the basis, otherwise we will miss the opportunity to bring the greatest benefits with the simplest strategy. Moreover, it can be seen that on the basis of a healthy lifestyle, further requiring blood pressure, blood sugar, and blood lipids to meet the standards only increases the benefits by 10%, because the disorders of blood pressure, blood sugar, and blood lipids are largely the mediating factors of an unhealthy lifestyle; but in any case, "three highs co-management (sugar and lipid suppression)" and even "four highs co-treatment (sugar, lipid, and obesity suppression)" should be a highly feasible and cost-effective chronic disease group prevention and control strategy.

Finally, how to deal with the current high incidence of fatty liver and even metabolic chronic diseases in China? From the perspective of "health-centered", we may consider the following:

Health Management 323:

Eat well, sleep well, exercise well,

Say no to obesity and stay away from tobacco.

The sugar and fat content should all meet the standards.

Follow the "Eight Elements of Life",

Stay healthy and don’t get worse!

References:

He P, Zhang Y, Ye Z, et al. A healthy lifestyle, Life's Essential 8 scores and new-onset severe NAFLD: A prospective analysis in UK Biobank [published online ahead of print, 2023 Jun 26]. Metabolism. 2023;146:155643. doi:10.1016/j.metabol.2023.155643

Editor | He Panpan and Zhang Yiwei

Audit | Qin Xianhui

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