Article Data

  • Views 217
  • Dowloads 106

Original Research

Open Access

Association between Cardiorespiratory Fitness, Muscle Strength, and Non-Alcoholic Fatty Liver Disease in Middle-Aged Men

  • Seol Jung Kang1
  • Seung Tae Park2
  • Gi Chul Ha3
  • Kwang Jun Ko3,*,

1Department of Physical Education, Changwon National University, 51140 Changwon-si, Republic of Korea

2Department of Yoga Studies & Meditation, Wonkwang Digital University, 07448 Wongkwang-si, Republic of Korea

3Department of Sports Medicine, National Fitness Center, 05540 Seoul-si, Republic of Korea

DOI: 10.31083/j.jomh1809184 Vol.18,Issue 9,September 2022 pp.1-8

Published: 22 September 2022

*Corresponding Author(s): Kwang Jun Ko E-mail:


Background: Nonalcoholic fatty liver disease (NAFLD) occurs when more than 5% of fat accumulates in the liver parenchyma without excess alcohol consumption. The objective of this study is to investigated the association between cardiorespiratory fitness (CRF), muscle strength (MS), and NAFLD. Methods: The subjects of this study were 1325 males aged 40-50 who had visited the National Fitness Center located in the Republic of Korea from 2017 to 2019. Abdominal ultrasonography testing was used for NAFLD diagnosis. For CRF, an MS test was used to measure maximal oxygen intake and grip strength. CRF and MS were classified into 3 quartiles (high, middle, low-level). In addition, both the CRF level and MS level were classified into 9 quadrants. Results: With confounding factors (age, body mass index, exercise, smoking) controlled, there was no relative risk of NAFLD between middle and high levels of CRF (95% CI, 0.92–2.17). However, the relative risk of NAFLD in the case of low-level CRF was 1.63-fold (95% CI, 1.03–2.60, p < 0.05) higher than that in the case of high-level CRF. Meanwhile, there was no significant difference between middle-level MS (95% CI, 0.68–1.65) and high-level MS (95% CI, 0.84–1.99) in terms of NAFLD relative risk. The NAFLD relative risk in the case of low-level CRF/MS was 2.27-fold (95% CI, 0.94–1.99, p < 0.05) higher than that of high-level CRF/MS. Conclusions: The low CRF and MS group had a higher risk of NAFLD compared with the high CRF and MS group. Maintenance of high CRF and MS may be beneficial in preventing NAFLD.


middle-aged men; nonalcoholic fatty liver disease; cardiorespiratory fitness; muscle strength

Cite and Share

Seol Jung Kang,Seung Tae Park,Gi Chul Ha,Kwang Jun Ko. Association between Cardiorespiratory Fitness, Muscle Strength, and Non-Alcoholic Fatty Liver Disease in Middle-Aged Men. Journal of Men's Health. 2022. 18(9);1-8.


[1] Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver dis-ease. Gastroenterology. 2002; 122: 1649–1657.

[2] Lee DS, Evans JC, Robins SJ, Wilson PW, Albano I, Fox CS, et al. Gamma Glutamyl Transferase and Metabolic Syndrome, Cardiovascular Disease, and Mortality Risk: The Framingham Heart Study. Arteriosclerosis, Thrombosis, and Vascular Biol-ogy. 2007; 27: 127–133.

[3] Marchesini G. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology. 2003; 37: 917–923.

[4] Rafiq N, Bai C, Fang Y, Srishord M, McCullough A, Gramlich T, et al. Long-Term Follow-up of Patients with Nonalcoholic Fatty Liver. Clinical Gastroenterology and Hepatology. 2009; 7: 234–238.

[5] Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64: 73–84.

[6] Birkenfeld AL, Shulman GI. Nonalcoholic fatty liver disease, hepatic insulin resistance, and type 2 Diabetes. Hepatology. 2014; 59: 713–723.

[7] Chang Y, Jung H, Yun KE, Cho J, Cho YK, Ryu S. Cohort Study of Non-alcoholic Fatty Liver Disease, NAFLD fibrosis score, and the Risk of Incident Diabetes in a Korean population. Amer-ican Journal of Gastroenterology. 2013; 108: 1861–1868.

[8] Cohen JC, Horton JD, Hobbs HH. Human Fatty Liver Disease: Old Questions and New Insights. Science. 2011; 332: 1519–1523.

[9] Cnop M, Landchild MJ, Vidal J, Havel PJ, Knowles NG, Carr DR, et al. The Concurrent Accumulation of Intra-Abdominal and Subcutaneous Fat Explains the Association between In-sulin Resistance and Plasma Leptin Concentrations: Distinct metabolic effects of two fat compartments. Diabetes. 2002; 51: 1005–1015.

[10] Marchesini G, Brizi M, Morselli-Labate AM, Bianchi G, Bu-gianesi E, McCullough AJ, et al. Association of nonalcoholic fatty liver disease with insulin resistance. The American Journal of Medicine. 1999; 107: 450–455.

[11] Nagle CA, Klett EL, Coleman RA. Hepatic tracylglycerol accu-mulation and insulin resistance. Journal of Lipid Research. 2009; 50: S74–S79.

[12] Kotronen A, Westerbacka J, Bergholm R, Pietiläinen KH, Yki-Järvinen H. Liver Fat in the Metabolic Syndrome. The Journal of Clinical Endocrinology & Metabolism. 2007; 92: 3490–3497.

[13] Kwak M, Kim D, Chung GE, Kim W, Kim JS. The preventive ef-fect of sustained physical activity on incident nonalcoholic fatty liver disease. Liver International. 2017; 37: 919–926.

[14] Perseghin G, Lattuada G, De Cobelli F, Ragogna F, Ntali G, Es-posito A, et al. Habitual Physical Activity is Associated with Intrahepatic Fat Content in Humans. Diabetes Care. 2007; 30: 683–688.

[15] Ryu S, Chang Y, Jung H, Yun KE, Kwon M, Choi Y, et al. Rela-tionship of sitting time and physical activity with non-alcoholic fatty liver disease. Journal of Hepatology. 2015; 63: 1229–1237.

[16] Fealy CE, Haus JM, Solomon TPJ, Pagadala M, Flask CA, Mc-Cullough AJ, et al. Short-term exercise reduces markers of hep-atocyte apoptosis in nonalcoholic fatty liver disease. Journal of Applied Physiology. 2012; 113: 1–6.

[17] Musso G, Cassader M, Rostina F, Gambino R. Impact of cur-rent treatments on liver disease, glucose metabolism and car-diovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomized trials. Dia-betologia. 2012; 55: 885–904.

[18] Artero EG, Jackson AS, Sui X, Lee D, O’Connor DP, Lavie CJ, et al. Longitudinal Algorithms to Estimate Cardiorespira-tory Fitness: Associations with Nonfatal cardiovascular disease and disease specific mortality. Journal of the American College of Cardiology. 2014; 63: 2289–2296.

[19] Kodama S. Cardiorespiratory Fitness as a Quantitative Pre-dictor of all-Cause Mortality and Cardiovascular Events in Healthy Men and Women: A meta-analysis. Journal of Amer-ican Medicine Association. 2009; 301: 2024–2035.

[20] Short KR, Vittone JL, Bigelow ML, Proctor DN, Rizza RA, Coenen-Schimke JM, et al. Impact of Aerobic Exercise Train-ing on Age-Related Changes in Insulin Sensitivity and Muscle Oxidative Capacity. Diabetes. 2003; 52: 1888–1896.

[21] Church TS, Kuk JL, Ross R, Priest EL, Biltoff E, Blair SN. As-sociation of Cardiorespiratory Fitness, Body Mass Index, and Waist Circumference to Nonalcoholic Fatty Liver Disease. Gas-troenterology. 2006; 130: 2023–2030.

[22] Croci I, Coombes JS, Bucher Sandbakk S, Keating SE, Nauman J, Macdonald GA, et al. Non-alcoholic fatty liver disease: Preva-lence and all-cause mortality according to sedentary behaviour and cardiorespiratory fitness. the HUNT Study. Progress in Car-diovascular Diseases. 2019; 62: 127–134.

[23] Medrano M, Labayen I, Ruiz JR, Rodríguez G, Breidenassel C, Castillo M, et al. Cardiorespiratory fitness, waist circumference and liver enzyme levels in European adolescents: the HELENA cross-sectional study. Journal of Science and Medicine in Sport. 2017; 20: 932–936.

[24] Kang S, Moon MK, Kim W, Koo BK. Association between mus-cle strength and advanced fibrosis in non‐alcoholic fatty liver disease: a Korean nationwide survey. Journal of Cachexia, Sar-copenia and Muscle. 2020; 11: 1232–1241.

[25] Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB. Fatty Liver: Imaging Patterns and Pitfalls. Radio-Graphics. 2006; 26: 1637–1653.

[26] Ahmed A, Wong RJ, Harrison SA. Nonalcoholic Fatty Liver Disease Review: Diagnosis, Treatment, and Outcomes. Clinical Gastroenterology and Hepatology. 2015; 13: 2062–2070.

[27] Seppälä-Lindroos A, Vehkavaara S, Häkkinen A, Goto T, West-erbacka J, Sovijärvi A, et al. Fat Accumulation in the Liver is As-sociated with Defects in Insulin Suppression of Glucose Produc-tion and Serum Free Fatty Acids Independent of Obesity in Nor-mal Men. The Journal of Clinical Endocrinology & Metabolism. 2002; 87: 3023–3028.

[28] Hao L, Wang Z, Wang Y, Wang Z, Znng Z. Association be-tween cardiorespiratory fitness, relative grip strength with non-alcoholic fatty liver disease. Medical Science Monitor. 2020; 26: e923015-1–e923015-8.

[29] Meng G, Wu H, Fang L, Li C, Yu F, Zhang Q, et al. Relationship between grip strength and newly diagnosed nonalcoholic fatty liver disease in a large-scale adult population. Scientific Reports. 2016; 6: 33255.

[30] Lee K. Relationship between Handgrip Strength and Nonalco-holic Fatty Liver Disease: Nationwide Surveys. Metabolic Syn-drome and Related Disorders. 2018; 16: 497–503.

[31] Johnson NA, Sachinwalla T, Walton DW, Smith K, Armstrong A, Thompson MW, et al. Aerobic exercise training reduces hep-atic and visceral lipids in obese individuals without weight loss. Hepatology. 2009; 50: 1105–1112.

[32] Sullivan S, Kirk EP, Mittendorfer B, Patterson BW, Klein S. Randomized trial of exercise effect on intrahepatic triglyceride content and lipid kinetics in nonalcoholic fatty liver disease. Hepatology. 2012; 55: 1738–1745.

[33] Hashida R, Kawaguchi T, Bekki M, Omoto M, Matsuse H, Nago T, et al. Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: a systematic review. Journal of Hepatology. 2017; 66: 142–152.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Directory of Open Access Journals (DOAJ) DOAJ is a unique and extensive index of diverse open access journals from around the world, driven by a growing community, committed to ensuring quality content is freely available online for everyone.

SCImago The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus® database (Elsevier B.V.)

Publication Forum - JUFO (Federation of Finnish Learned Societies) Publication Forum is a classification of publication channels created by the Finnish scientific community to support the quality assessment of academic research.

Scopus CiteScore 0.7 (2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Norwegian Register for Scientific Journals, Series and Publishers Search for publication channels (journals, series and publishers) in the Norwegian Register for Scientific Journals, Series and Publishers to see if they are considered as scientific. (

Submission Turnaround Time