Association Between Volume, Intensity and Rhythm of Physical Activity Measured by Accelerometer and Risk of All‐Cause and Cause‐Specific Mortality in Individuals With MASLD

ABSTRACT Background Individuals with metabolic dysfunction‐associated steatotic liver disease (MASLD) have a higher mortality risk, and physical activity is important to MASLD management. However, a comprehensive exploration of associations of volume and intensity of physical activity and rest‐activity rhythm (RAR) based on an accelerometer with all‐cause and cause‐specific mortality in MASLD individuals was scarce. Methods We included 10,143 individuals with MASLD from the UK Biobank. Volume and intensity of physical activity [low‐intensity physical activity (LPA), moderate‐to‐vigorous‐intensity physical activity (MVPA) and sedentary time] and RAR (amplitude, mesor, pseudo‐F statistics and acrophase) were computed from accelerometer data. The Cox proportional hazards model was used to estimate the relationships of volume and intensity of physical activity and RAR with all‐cause, cardiovascular disease (CVD) and cancer mortality risk in individuals with MASLD and further in common subtypes of cardiometabolic abnormalities. The population attributable risk and relative importance of physical activity were estimated. Results Higher LPA, MVPA and normal RAR (amplitude and mesor) were associated with decreased risk of all‐cause and CVD mortality among individuals with MASLD (HRs: 0.712–0.805), especially of all‐cause mortality in those with common subtypes of more than two metabolic abnormalities (overweight/obesity‐elevated blood pressure‐hyperlipidemia and all the four abnormalities). Furthermore, we found MVPA and amplitude represented relatively important contributors to all‐cause and CVD mortality risk in individuals with MASLD. Conclusions In individuals with MASLD, a higher volume and intensity of physical activity, as well as normal RAR supported lower all‐cause and CVD mortality risk, which provided insights for management guidelines.