Cardiorespiratory fitness is inversely associated with non-invasive markers of hepatic steatosis and fibrosis: a cross-sectional study of 39,197 UK adults.
16 affiliations
- 1National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
- 2NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK.
- 3Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
- 4Nuffield Health Research Group, Nuffield Health, Epsom, UK.
- 5Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- 6Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
- 7Division of Gastroenterology and Hepatology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
- 8School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia.
- 9Centre for Cardiovascular Research, Innovation and Development, Cardiff Metropolitan University, Cardiff, UK.
- 10Centre for Health, Activity and Wellbeing Research, Cardiff Metropolitan University, Cardiff, UK.
- 11Laboratory of the Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, Clermont-Ferrand, France.
- 12International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France.
- 13Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
- 14NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
- 15National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK. [email protected].
- 16NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK. [email protected].
Abstract
Background
Cardiorespiratory fitness (CRF) is a powerful predictor of numerous health outcomes; however, its relationship with liver health remains unclear. This study examined the associations of CRF with non-invasive markers of liver steatosis and fibrosis in a large, health-screening cohort, and explored potential effect modification by demographic, cardiometabolic, and clinical factors.Methods
In this independent healthcare-based cross-sectional study of 39,197 UK adults (32% female; mean ± SD, age 45.8 ± 9.0 years), CRF was objectively estimated as peak oxygen uptake (ml∙kg⁻¹∙min⁻¹) during submaximal treadmill and cycle ergometer tests. Hepatic steatosis and fibrosis were defined using validated non-invasive indices: Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) for steatosis, and Fibrosis-4 Index (FIB-4) and NAFLD Fibrosis Score (NFS) for fibrosis. Multinomial logistic regression examined associations between CRF and low-, intermediate-, and high-risk categories for each index, adjusting for demographic, cardiometabolic, and clinical covariates (excluding component variables of the respective indices).Results
For FLI and HSI, each 1 ml∙kg⁻¹∙min⁻¹ higher CRF was associated with 3-5% lower odds of intermediate steatosis risk and 8-9% lower odds of high steatosis risk (P < 0.001). For FIB-4 and NFS, higher CRF was associated with 1-3% lower odds of intermediate fibrosis risk and 2-6% lower odds of high fibrosis risk (P ≤ 0.011). Associations were stronger in females and weaker in individuals with less favourable metabolic profiles.Conclusions
Higher CRF was associated with lower odds of hepatic steatosis and fibrosis across multiple validated non-invasive indices. These findings highlight CRF as an integrative biomarker of hepatic and cardiometabolic health, and modifiable target for steatotic liver disease prevention and management.
Related
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- Prevalence and Severity of Hepatic Steatosis and Fibrosis Across Glycemic Categories Among Patients Attending a Tertiary Care Hospital: A FibroScan-Based Cross-Sectional Study
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BibTeX
@article{willis2026cardiorespiratory,
title = {{Cardiorespiratory fitness is inversely associated with non-invasive markers of hepatic steatosis and fibrosis: a cross-sectional study of 39,197 UK adults.}},
author = {Scott A Willis and Kevin Deighton and Christopher Goodwin and Daniel J Cuthbertson and Jonathan G Stine and Shelley E Keating and Christopher J A Pugh and Gaël Ennequin and David J Stensel and Guruprasad P Aithal and James A King},
journal = {BMC gastroenterology},
year = {2026},
month = jul,
doi = {10.1186/s12876-026-05137-1},
url = {https://europepmc.org/article/MED/42928097},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Cardiorespiratory fitness is inversely associated with non-invasive markers of hepatic steatosis and fibrosis: a cross-sectional study of 39,197 UK adults.
AU - Scott A Willis
AU - Kevin Deighton
AU - Christopher Goodwin
AU - Daniel J Cuthbertson
AU - Jonathan G Stine
AU - Shelley E Keating
AU - Christopher J A Pugh
AU - Gaël Ennequin
AU - David J Stensel
AU - Guruprasad P Aithal
AU - James A King
PY - 2026
DA - 2026/07/29
JO - BMC gastroenterology
DO - 10.1186/s12876-026-05137-1
UR - https://europepmc.org/article/MED/42928097
AB - Background Cardiorespiratory fitness (CRF) is a powerful predictor of numerous health outcomes; however, its relationship with liver health remains unclear. This study examined the associations of CRF with non-invasive markers of liver steatosis and fibrosis in a large, health-screening cohort, and explored potential effect modification by demographic, cardiometabolic, and clinical factors.Methods In this independent healthcare-based cross-sectional study of 39,197 UK adults (32% female; mean ± SD, age 45.8 ± 9.0 years), CRF was objectively estimated as peak oxygen uptake (ml∙kg⁻¹∙min⁻¹) during submaximal treadmill and cycle ergometer tests. Hepatic steatosis and fibrosis were defined using validated non-invasive indices: Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) for steatosis, and Fibrosis-4 Index (FIB-4) and NAFLD Fibrosis Score (NFS) for fibrosis. Multinomial logistic regression examined associations between CRF and low-, intermediate-, and high-risk categories for each index, adjusting for demographic, cardiometabolic, and clinical covariates (excluding component variables of the respective indices).Results For FLI and HSI, each 1 ml∙kg⁻¹∙min⁻¹ higher CRF was associated with 3-5% lower odds of intermediate steatosis risk and 8-9% lower odds of high steatosis risk (P < 0.001). For FIB-4 and NFS, higher CRF was associated with 1-3% lower odds of intermediate fibrosis risk and 2-6% lower odds of high fibrosis risk (P ≤ 0.011). Associations were stronger in females and weaker in individuals with less favourable metabolic profiles.Conclusions Higher CRF was associated with lower odds of hepatic steatosis and fibrosis across multiple validated non-invasive indices. These findings highlight CRF as an integrative biomarker of hepatic and cardiometabolic health, and modifiable target for steatotic liver disease prevention and management.
SN - 1471-230X
ER -