Study links lifestyle choices and gender to severity of fatty liver disease in workers

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In a recent study published in the journal Dr nutrientsThe researchers determined whether factors such as lifestyle, gender, and risk of inflammation, liver dysfunction, and metabolic abnormalities were associated with the severity of fatty liver disease.

Study: Unraveling the association between gender, lifestyle, and severity of fatty liver with health risks in workers. Image credit: Peakstock /


Non-alcoholic fatty liver disease is thought to affect one-third of the world’s population, with an estimated prevalence of around 30% in Asia. Furthermore, several studies have reported incidence rates between 28% and 52% in adults aged 17 to 65 years.

Non-alcoholic fatty liver disease increases the risk of multisystemic illnesses such as metabolic abnormalities, cardiovascular disease, renal problems and type 2 diabetes. Moreover, the disease can progress to liver cirrhosis, acute hepatitis and eventually hepatocellular carcinoma.

Genetic, metabolic, epigenetic and lifestyle-related factors may contribute to the etiology of fatty liver disease. Individuals who are genetically susceptible to the disease are at risk of developing fatty liver disease when they are sedentary and participate in unhealthy lifestyles, which lead to fat accumulation and adiposity. Growing evidence also suggests that gender may be a significant determinant of fatty liver disease risk.

About the study

The present study was conducted as part of the Taiwan Workplace Health Promotion Project, which aims to periodically assess workers’ health-related needs and hazards. Participation in the study was voluntary, and each participant was asked to answer a questionnaire with a health worker, with all responses coded for anonymity and confidentiality.

Individuals over the age of 20 were recruited for the study from three industrial enterprises in central Taiwan involved in manufacturing transportation equipment, automobile parts, and electronic components. Health-related lifestyle habits, including physical activity levels, dietary choices, alcohol consumption, and smoking behavior, were assessed through a self-administered questionnaire. The nutrition and exercise categories included nine and eight items, respectively, with responses rated on a four-point Likert scale.

Nutrition categories relate to low-fat food choices, limited sugar consumption, fruits, vegetables, cereals, poultry, eggs, nuts, fish, meat, legumes and dairy foods, as well as knowledge of the nutritional content of foods. On food labels. The exercise section examines engagement and adherence to physical activity, frequency and intensity of physical activity, and pulse and heart rate monitoring during exercise.

Based on smoking behavior, participants were classified as non-smokers, occasional smokers, or daily smokers. Alcohol consumption was categorized as occasional and daily drinking.

Ultrasound images were used to assess the severity of fatty liver with grades including absence of mild, moderate, and severe fatty liver. Data such as systolic and diastolic blood pressure, waist circumference, triglyceride levels, fasting blood glucose and high-density lipoprotein levels were also collected to assess metabolic risk factors.

Platelets and white blood cells were examined to identify cardiovascular and inflammatory biomarkers. Glutamate pyruvate transaminase and glutamate oxaloacetate transaminase levels were also measured to assess liver function.

Study results

A gender-based trend in the prevalence of fatty liver, unhealthy lifestyle choices and health risks was observed, with men at greater risk than women. About 45% of participants had fatty liver. Furthermore, health behavior questionnaire scores showed that physical activity levels and fatty liver severity were negatively correlated.

Fatty liver severity category varied among current alcohol drinkers, with the no fatty liver group comprising 43% of current alcohol drinkers and the mild, moderate, and severe fatty liver categories comprising 48.4%, 44.8%, and 63.4% of current alcohol drinkers, respectively.

The severity of fatty liver was associated with a higher risk of metabolic abnormalities. Liver dysfunction and inflammation also demonstrate a positive correlation with the severity of fatty liver.

The prevalence of non-alcoholic fatty liver in men compared to women may be explained by differences in lifestyle habits between men and women in the Taiwanese population. Male workers were found to engage in unhealthy lifestyle habits such as poor food choices, increased smoking and higher alcohol consumption than female workers. Other studies have also reported that women engage more in health-promoting lifestyle habits and choices.

Severe fatty liver was associated with certain parameters that indicate a higher risk of cardiovascular disease and metabolic abnormalities, such as high blood pressure, large waist circumference, and elevated triglyceride levels.


In the Taiwanese worker population examined in the current study, the prevalence of fatty liver was 45.5%, with men at higher risk of fatty liver and other related health risks than women. The prevalence of non-alcoholic fatty liver was associated with lower physical activity levels, as well as unhealthy lifestyle habits such as poor diet, smoking behavior and high alcohol consumption.

The risk of liver dysfunction and inflammation was also higher for those with severe fatty liver. These findings highlight the need to promote health-enhancing lifestyle choices.

Journal Reference:

  • Tang, F., Li, R., & Huang, J. (2023). Unraveling the association between gender, lifestyle, and severity of fatty liver with health risks in workers. nutrients 15(22). doi:10.3390/nu15224765

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