A healthy lifestyle during adolescence was inversely associated with fatty liver indices in early adulthood - findings from the DONALD cohort study.

A healthy lifestyle during adolescence might be associated with insulin sensitivity or liver enzyme levels and thus contribute to the prevention of non-alcoholic fatty liver disease (NAFLD) later in life. Therefore, we examined the association between adherence to a hypothesis-based lifestyle score including dietary intake, physical activity, sedentary behaviour, sleep duration and body mass index in adolescence and fatty liver indices in early adulthood. Overall, 240 participants of the DONALD study completed repeated measurements of the lifestyle score factors during adolescence (females: 8.5-15.5 years, males: 9.5-16.5 years). Multivariable linear regression models were used to investigate the prospective association between adolescent lifestyle scores and NAFLD risk (hepatic steatosis index (HSI) and the fatty liver index (FLI)) in early adulthood (18-30 years). Participants visited the study centre 4.9 times during adolescence and achieved 2.8 (0.6-5) out of 5 lifestyle score points on average. Inverse associations were observed between the lifestyle score during adolescence and fatty liver indices in young adulthood (HSI: -5.8% [-8.3 to -3.1%], p<0.0001, FLI: -32.4% [-42.9 to -20.0%], p<0.0001) in the overall study population. Sex-stratified analysis confirmed these results in men, while inverse but non-significant associations were observed in women (p>0.05). A higher lifestyle score during adolescence was associated with lower HSI and FLI values, suggesting that a healthy lifestyle during adolescence might contribute to NAFLD prevention, predominantly in men. Our findings on repeatedly measured lifestyle scores in adolescents and their association with fatty liver indices in early adulthood warrant confirmation in larger study populations.