Eur J Med Res. 2025 Dec 26. doi: 10.1186/s40001-025-03707-9. Online ahead of print.
ABSTRACT
OBJECTIVES: Aimed to reveal the complex associations between Life’s Essential 8 (LE8), depressive symptoms and nonalcoholic fatty liver disease (NAFLD), and to explore the mediating role of depressive symptoms in the pathways of LE8 components affecting NAFLD.
METHODS: Based on nationally representative data of 8908 adults ≥ 20 years from the 2005-2018 National Health and Nutrition Examination Survey (NHANES), weighted logistic, regression, restricted cubic spline(RCS), threshold effect and bootstrap mediated-effects analyses were used to assess the association between LE8, NAFLD and depressive symptoms associations, and stratified analysis reveals the heterogeneity of the association in population.
RESULTS: Each one-point increase in the LE8 was associated with a reduced risk of NAFLD, OR (95% CI) = 0.19(0.16, 0.23), with health factor score showing particularly protective effect, OR (95% CI) = 0.09 (0.07, 0.10). These associations were stronger among women, older, and PIR (poverty-to-income ratio) > 3.5. A dose-response relationship was evident, with a positive correlation between severe depression and NAFLD, OR (95% CI) = 2.01(1.05, 3.85). Crucially, depressive symptoms constituted a significant mediating pathway in health behaviors, accounting for 46.78%, 17.74%, and 5.79% of the protective effects of optimal sleep health, adequate physical activity, and diet on NAFLD, respectively. Regarding nicotine exposure, depressive symptoms exerted a partial inhibitory effect, with the mediating effect accounting for -27.55%. However, for the association between health factors and NAFLD, depressive symptoms do not play a mediating role in the association.
CONCLUSIONS: This study is the first to confirm that depressive symptoms mediate the relationships between specific LE8 components and NAFLD. LE8 components are significantly correlated with NAFLD, possibly via depression-supporting a “physiological-psychological” integrated approach to NAFLD management. Targeted interventions for depressive symptoms may augment the benefits of optimized LE8 in high-risk populations.
PMID:41454340 | DOI:10.1186/s40001-025-03707-9
