Associations of Metabolic Dysfunction-Associated Fatty Liver Disease and Physical Activity with Knee Osteoarthritis in Middle-Aged and Older Women

PURPOSE: This study examined the associations between the independent and combined levels of metabolic dysfunction-associated fatty liver disease (MAFLD) and physical activity (PA) with knee osteoarthritis (KOA) in women aged ≥50 years.METHODS: A total of 6,688 women aged ≥50 years who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2013 were included. The participants were classified into Case and Normal groups based on the presence of MAFLD, and into Active and Inactive groups based on compliance with the World Health Organization’s PA guidelines. Binary logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for KOA according to the independent and combined levels of MAFLD and PA.RESULTS: After adjusting for covariates, significantly higher ORs for KOA were observed in the Case group (OR=1.757, <i>p</i><.001) than in the Normal and Inactive groups (OR=1.181, <i>p</i><.001). In the combined analysis, all groups (Normal & Inactive: OR=1.281, <i>p</i>=.033; Case & Active: OR=1.672, <i>p</i><.001; Case & Inactive: OR=2.079, <i>p</i><.001) showed significantly higher ORs for KOA compared to the Normal & Active group.CONCLUSIONS: These findings highlight the importance of MAFLD management and regular PA for KOA prevention in middle-aged and older women. Moreover, regular PA may be an effective strategy for reducing KOA risk in individuals with MAFLD.