DAY 2: Physical Activity May Improve Survival for People With Steatotic Liver Disease

Findings from a population-based study spanning three decades showed that engaging in regular physical activity may reduce mortality odds for people living with steatotic liver disease, and may particularly benefit individuals who previously led completely sedentary lifestyles.

“Among patients with metabolic dysfunction-associated steatotic liver disease (MASLD), cardiovascular disease is the leading cause of death,” said Sahiljot Singh Bhupal, MD, an internal medicine resident at the St. Francis Medical Center, in Lynwood, California, who presented the results at the 2026 Annual Scientific Meeting of the American College of Gastroenterology. “Physical activity has been shown to reduce hepatic steatosis and improve cardiometabolic risk even in the absence of weight loss.”

Previous research has shown that engaging in moderate physical activity during leisure time may reduce the risk of advanced fibrosis among patients with all types of steatotic liver disease, including those with MASLD [Dunn et al. Hepatol Commun 2025:e0797].

Bhupal and colleagues used data from the Third National Health and Nutrition Examination Survey (NHANES III,) collected from 1988 to 1994, and looked at corresponding mortality data through 2019 to determine whether regular physical activity is associated with improved survival odds for patients with steatotic liver disease. Participants who engaged in any amount of physical activity during leisure time were considered physically active.

The analyzed cohort included 4,441 people aged 20 to 74 years who were diagnosed with steatotic liver disease, most of whom had MASLD (85.5%). After weighting, the sample was representative of approximately 46 million adults. Records that were missing mortality data or physical activity data were excluded, as were those that did not show cardiometabolic risk factors, alcohol intake information, or ultrasound-based diagnoses of steatosis. Participants were followed for a median period of 26 years, during which 1,903 deaths were documented. The results showed that cumulative mortality was significantly lower among physically active participants (36.4%) compared with their inactive counterparts (44%).

“Leisure-time physical activity was independently associated with lower long-term all-cause mortality [rates],” Bhupal reported, noting that physically active participants had a 24% lower unadjusted risk of all-cause mortality. “After sequential adjustment for demographic, socioeconomic, and clinical factors, leisure-time physical activity remained independently associated with a 16% lower risk of all-cause mortality,” he added. 

When looking at disease subtypes, the authors found that the benefit of leisure-time physical activity on mortality odds was significant only for MASLD. Bhupal explained that, although baseline liver fibrosis was a strong predictor of mortality, it did not influence the association between physical activity and mortality odds, suggesting that the survival benefit was largely driven by extrahepatic cardiometabolic mechanisms. 

“The survival benefit was greatest during the first decade after baseline assessment, suggesting that a single baseline measurement becomes a progressively poorer reflection of habitual physical activity over long-term follow-up,” Bhupal remarked. “The greatest mortality reduction occurred when participants moved from complete inactivity to modest levels of physical activity. This was also strongest during the first decade after baseline assessment, reflecting changes in physical activity over time.”