Clustering of lifestyle behaviors and analysis of their associations with MAFLD: a cross- sectional study of 196515 in China

Introduction: The aggregation of lifestyle behaviors and their association with metabolic associated fatty liver disease (MAFLD) remains unclear. We identified lifestyle patterns and investigated their association with MAFLD in a sample of Chinese adults who underwent annual physical examinations. Methods Annual physical examination data of Chinese adults from January 2016 to December 2020 was used in this study. We created a scoring system for lifestyle items combining statistical method (Multivariate analysis of variance) and clinical expertise’s opinion (Delphi method). Subsequently, principal components analysis and two-step cluster analysis were implemented to derive lifestyle patterns of men and women. Binary logistic regression analysis was used to explore the prevalence risk of MAFLD among lifestyle patterns stratified by gender. Results A total of 196,515 subjects were included in the analysis. Based on the defined lifestyle scoring system, nine and four lifestyle patterns were identified for men and women, respectively, which included “healthy or unhealthy” patterns and mixed patterns containing a combination of healthy and risky lifestyle behaviors. This study showed that subjects with an unhealthy or mixed pattern had a differentially higher risk of developing MAFLD than subjects with a relatively healthy pattern, especially among men. Conclusions Clusters of unfavorable behaviors are more prominent in men when compared to women. Lifestyle patterns, as the important factors influencing the development of MAFLD, show significant gender differences in the risk of MAFLD. There is a strong need for future research to develop targeted MAFLD interventions based on the identified behavioral clusters by gender stratification.