Vilar-Gomez E, Nephew LD, Vuppalanchi R, et al. - In the US population, a lower risk of NAFLD was observed in relation to high-quality diet (HQD), increased physical activity, and college education.

• In this cross-sectional analysis of the National Health and Nutrition Examination Surveys, 2017–2018, which comprised 3,589 participants, the association among diet quality (DQ), physical activity (PA), socioeconomic status (SES), and NAFLD risk was investigated.

• Physically active participants (≥600 metabolic equivalent of task [MET] min/week) exhibited a lower risk of NAFLD than inactive participants (<600 MET min/week) (OR: 0.71).

• An association of a HQD (Healthy Eating Index > 56.64) with a lower risk of NAFLD (OR: 0.58) was found, vs a non-HQD.

• Participants who were physically active with HQD were found to have the lowest NAFLD risk (OR: 0.43).

• The impact of DQ and PA on NAFLD risk was significantly mediated by body mass index and waist circumference.

• Education (college or above) (OR: 0.65), but not poverty income ratio, was identified to be linked with a decreased NAFLD risk.

• Partial mediators of the effect of education on NAFLD risk included HQD and increased PA.

• The total impact of education on NAFLD risk mediated by DQ and PA was 29% and 8%, respectively.