Heredia NI, Zhang X, Balakrishnan M, et al. - In this study, diet quality and physical activity (PA) were found to be related to decreased odds of non-alcoholic fatty liver disease (NAFLD), and PA could be critical even for those with advanced liver disease. Targeted public health interventions should be focused on these behaviors.

• A representative sample of U.S. adults (n=2,892) from the 2017-2018 National Health and Nutrition Examination Survey was cross-sectionally analyzed to examine the association of PA and diet quality with NAFLD and NAFLD-related fibrosis by using a more precise form of measuring NAFLD.

• Decreased odds of NAFLD were reported in relation to high adherence to U.S. dietary recommendations (highest vs lowest Healthy Eating Index-2015 tertile) and more PA (middle tertile vs lowest), with adjusted ORs 0.60 and 0.65, respectively.

• More PA was found to be inversely related to advanced fibrosis (adjusted OR = 0.35).