Interrelationship between physical activity and depression in nonalcoholic fatty liver disease

Table 1 Demographic, lifestyle and general health comorbidities of participants according to the presence of nonalcoholic fatty liver disease

	All (n = 589)	Non-NAFLD (n = 354)	NAFLD (n = 235)	P value
Age, mean ± SD	59.97 ± 6.97	59.99 ± 7.40	59.94 ± 6.29	0.3959
Male, %	254 (43.12%)	131 (37.01%)	123 (52.34%)	0.0002
White, %	564 (95.76%)	340 (96.05%)	224 (95.32%)	0.6686
Smoking status, %
Current	70 (11.90%)	47 (13.31%)	23 (9.79%)	0.1958
Former	239 (40.65%)	141 (39.94%)	98 (41.70%)	0.6706
Non-smoker	279 (47.45%)	165 (46.74%)	114 (48.51%)	0.674
Regular exercise, %
Physically Inactive	171 (29.03%)	85 (24.01%)	86 (36.60%)	0.001
Moderate physical activity	230 (39.05%)	139 (39.27%)	91 (38.72%)	0.8949
Ideal physical activity	188 (31.92%)	130 (36.72%)	58 (24.68%)	0.0021
Obesity, % BMI
Lean	270 (45.84%)	255 (72.03%)	15 (6.38%)	< 0.0001
Overweight	234 (39.73%)	99 (27.97%)	135 (57.45%)	< 0.0001
Obese	85 (14.43%)	0 (0.00%)	85 (36.17%)	< 0.0001
History of CVD, %	40 (6.79%)	23 (6.50%)	17 (7.23%)	0.7278
History of arthritis, %	68 (11.54%)	39 (11.02%)	29 (12.34%)	0.6226
History of cancer (any), %	97 (16.47%)	48 (13.56%)	49 (20.85%)	0.0195
Insulin resistance, %	157 (26.66%)	48 (13.56%)	109 (46.38%)	< 0.0001
Hypertension, %	117 (19.86%)	66 (18.64%)	51 (21.70%)	0.3623
Hyperlipidemia, %	446 (75.72%)	245 (69.21%)	201 (85.53%)	< 0.0001
Diabetes, %	74 (12.56%)	19 (5.37%)	55 (23.40%)	< 0.0001
Metabolic syndrome1, %	125 (21.26%)	23 (6.52%)	102 (43.40%)	< 0.0001
BDI, mean ± SD	4.00 ± 3.71	3.67 ± 3.62	4.49 ± 3.80	0.0041

CVD: Cardiovascular disease; NAFLD: Nonalcoholic fatty liver disease; SD: Standard deviation. NCEP ATP III (2005 revision).

¹P value by nonparametric Kruskal-Wallis Test for continuous variables, chi-square test for categorical variable, Data are presented as the mean ± SD for numerical variables and count (%) for categorical variables.

Table 2 Demographic, lifestyle and general health comorbidities of participants according to the presence of depression and nonalcoholic fatty liver disease

	Individuals with NAFLD			Individuals without NAFLD
	No depression (n = 207)	Depression (n = 28)	P value	No depression (n = 327)	Depression (n = 27)	P value
Age, mean ± SD	59.91 ± 6.34	60.15 ± 6.00	0.9433	60.02 ± 7.32	59.61 ± 8.44	0.9813
Male, %	115 (55.56%)	8 (28.57%)	0.0073	125 (38.23%)	6 (22.22%)	0.0978
White, %	197 (95.17%)	27 (96.43%)	0.7671	316 (96.64%)	24 (88.89%)	0.0471
Smoking status, %
Current	19 (9.18%)	4 (14.29%)	0.3934	41 (12.58%)	6 (22.22%)	0.1563
Former	86 (41.55%)	12 (42.86%)	0.8949	133 (40.80%)	8 (29.63%)	0.2549
Non-smoker	102 (49.28%)	12 (42.86%)	0.5236	152 (46.63%)	13 (48.15%)	0.8789
Regular exercise, %
Physically inactive	69 (33.33%)	17 (60.71%)	0.0048	75 (22.94%)	10 (37.04%)	0.0992
Moderate physical activity	86 (41.55%)	5 (17.86%)	0.0157	129 (39.45%)	10 (37.04%)	0.8051
Ideal physical activity	52 (25.12%)	6 (21.43%)	0.6706	123 (37.61%)	7 (25.93%)	0.2259
Obesity, % BMI
Lean	13 (6.28%)	2 (7.14%)	0.8609	232 (70.95%)	23 (85.19%)	0.1132
Overweight	118 (57.00%)	17 (60.71%)	0.7094	95 (29.05%)	4 (14.81%)	0.1132
Obese	76 (36.71%)	9 (32.14%)	0.6365	0 (0.00%)	0 (0.00%)	-------
History of CVD, %	14 (6.76%)	3 (10.71%)	0.4488	21 (6.42%)	2 (7.41%)	0.8417
History of arthritis, %	21 (10.14%)	8 (28.57%)	0.0054	37 (11.31%)	2 (7.41%)	0.5331
History of any cancer, %	46 (22.22%)	3 (10.71%)	0.1595	47 (14.37%)	1 (3.70%)	0.1196
Insulin resistance, %	97 (46.86%)	12 (42.86%)	0.6902	47 (14.37%)	1 (3.70%)	0.1196
Hypertension, %	44 (21.26%)	7 (25.00%)	0.6519	61 (18.65%)	5 (18.52%)	0.9861
Hyperlipidemia, %	177 (85.51%)	24 (85.71%)	0.9767	226 (69.11%)	19 (70.37%)	0.8918
Diabetes, %	50 (24.15%)	5 (17.86%)	0.4601	16 (4.89%)	3 (11.11%)	0.1682
Metabolic syndrome1, %	91 (43.96%)	11 (39.29%)	0.6394	21 (6.44%)	2 (7.41%)	0.8451

CVD: Cardiovascular disease; SD: Standard deviation; NAFLD: Nonalcoholic fatty liver disease, NCEP ATP III (2005 revision).

¹P value by nonparametric Kruskal-Wallis Test for continuous variables, chi-square test for categorical variable. Data are presented as the mean ± SD for numerical variables and count (%) for categorical variables.

Table 3 Univariable and multivariable changes in beck depression inventory according to physical activity, stratified by the presence of nonalcoholic fatty liver disease

	NAFLD		Non-NAFLD
	% change (95%CI)	P	% change (95%CI)	P
Unadjusted	-16.91 (-26.28 - -6.35)	0.0024	-8.96 (-18.25 - 1.38)	0.0871
Age-sex adjusted	-14.74 (-24.42 - -3.83)	0.0095	-6.79 (-16.35 - 3.87)	0.203
Model 1	-14.6 (-24.34 - -3.61)	0.01	-3.43 (-13.64 - 7.98)	0.54
Model 2	-16.12 (-25.6 - -5.44)	0.004	-3.27 (-13.49 - 8.15)	0.5592

Generalized linear regression with a gamma error distribution and a log-link function. Level of Physical activity is defined as a continuous variable (1 = inactive, 2 = moderate, 3 = Ideal); Model 1 adjusted for Physical activity, age, sex, current smoker, DM, hypertension, hyperlipidemia and obesity; Model 2 adjusted for all variables in model 1 + history of CVD and history of cancer. NAFLD: Nonalcoholic fatty liver disease.

Table 4 Univariable and multivariable changes in beck depression inventory score according to the presence of nonalcoholic fatty liver disease and level of physical activity

	Unadjusted		Age-sex adjusted		Model 1		Model 2
Group	% change (95%CI)	P	% change (95%CI)	P	% change (95%CI)	P	% change (95%CI)	P
Non-NAFLD with physical ideal	Reference		Reference		Reference		Reference
Non-NAFLD with physical moderate	16.67 (-3.33 - 40.82)	0.108	11.5 (-7.68 - 34.67)	0.2584	7.77 (-11.05 - 30.58)	0.4447	6.99 (-11.65 - 29.56)	0.4891
Non-NAFLD with physical inactivity	19.85 (-2.87 - 47.89)	0.0913	14.15 (-7.5 - 40.87)	0.2174	8.25 (-12.74 - 34.29)	0.4708	8.34	0.4645
							(-12.58 - 34.26)
NAFLD with physical ideal	1.23 (-20.04 - 28.15)	0.919	3.31 (-18.23 - 30.53)	0.7849	-2.43 (-24.49 - 26.08)	0.851	-2.19 (-24.33 - 26.45)	0.866
NAFLD with physical moderate	23.08 (-0.09 - 51.63)	0.051	23.99 (0.79 - 52.53)	0.042	15.68	0.206	16.24 (-7.23 - 45.65)	0.1911
					(-7.7 - 44.98)
NAFLD with physical inactivity	46.84 (19.28 - 80.75)	0.0003	43.06 (16.39 - 75.84)	0.0007	35.02 (8.03 - 68.74)	0.0083	36.25 (9.1 - 70.16)	0.0064

Generalized linear regression with a gamma error distribution and a log-link function. Level of Physical activity is defined as a continuous variable (1 = Poor, 2 = moderate, 3 = Ideal); Model 1 adjusted for Physical activity, age, sex, current smoker, DM, hypertension, hyperlipidemia and obesity; Model 2 adjusted for all variables in model 1 + history of CVD and history of cancer. NAFLD: Nonalcoholic fatty liver disease.