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Poor Sleep Habits, Behaviors Could Increase Risk of Fatty Liver Disease

An analysis of a prospective cohort study in China provides evidence suggesting poor sleep behaviors, including daytime napping and nighttime sleep disturbances, could increase risk of metabolic dysfunction-associated fatty liver disease.

New research is underlining the importance of healthy sleep behaviors on overall health and, more specifically, for reducing risk of metabolic dysfunction-associated fatty liver disease (MAFLD).

A cross-sectional analysis of self-reported sleep behaviors from more than 5000 adults with fatty liver disease, results of the study found reporting poor sleep behaviors, including late bedtime, snoring, and daytime napping for over 30 minutes, were significantly associated with increased odds of MAFLD, even after full adjustment for obesity and other factors, with a more than 2-fold increase in likelihood observed among patients reporting disturbances in nighttime sleep and prolonged daytime napping.

“People with poor nighttime sleep and prolonged daytime napping have the highest risk for developing fatty liver disease,” said Yan Liu, PhD, of the Guangdong Provincial Key Laboratory of Food, Nutrition and Health and Sun Yat-sen University in Guangzhou, China, in a statement. “Our study found a moderate improvement in sleep quality was related to a 29% reduction in the risk for fatty liver disease.”

With previous reports suggesting fatty liver disease might impact up to 1-in-4 adults worldwide, Liu and a team of colleagues sought to explore how sleep behaviors might influence the risk of developing MAFLD in the wake of newer data suggesting sleep disturbances could play a role in the development of other metabolic disorders. TO do so, investigators designed a cross-sectional study using data from the South China Cohort (SCC) study, which was a community-based prospective cohort study conducted across Southern China. With SCC enrolling 5430 individuals aged 30-79 years with no severe disability at baseline, the trial provided investigates with a cohort of 5011 participants with self-reported sleep behavior and radiologically diagnosed MAFLD for inclusion in the current study.

Per SCC protocol, MAFLD was based on diagnosed based on ultrasound examination of hepatic steatosis and the precedence of oversight/obesity, diabetes mellitus, or evidence of metabolic dysregulation. Sleep behavior were assessed using the Pittsburgh Sleep Quality Index questionnaire. Overall sleep scores were a composite of 5 nocturnal sleep factors and daytime napping, with a healthy sleep score considered 5 or greater, intermediate defined as a score of 3 or 4, and poor defined as a score of 2 or below. Investigators pointed out associations between sleep behaviors and MAFLD were assessed using multivariate logistic regression adjusting for demographics, lifestyles, medication and metabolic comorbidities and mediation analysis was used to estimate the impact of obesity on MAFLD risk.

Upon analysis, results suggest late bedtime, snoring, and daytime napping for more than 30 minutes were all significantly associated with increased risks of MAFLD, with increases in likelihood of 1.37- (95% CI, 1.10-1.70), 1.59- (95% CI, 1.33-1.91), and 1.17-fold (95% CI, 1.02-1.35), respectively in fully adjusted analyses. Further analysis suggested those with disturbances in nighttime sleep and prolonged daytime napping had the greatest risk of MAFLD, with a 2.38-fold increase in risk of MAFLD (OR, 2.38 [95% CI, 1.73-3.27]). Investigators noted each increase in healthy sleep score was associated with a 16% reduction in MAFLD risk.

Additional analyses found individuals with a sedentary lifestyle and central obesity were more likely to experience prominent adverse effects from poor sleep quality than other individuals included in the study. Investigators also noted obesity accounted for 20.77% of the total effect of sleep quality on MAFLD risk.

“Our study provides evidence that even a moderate improvement in sleep quality is sufficient to reduce the risk for fatty liver disease, especially in those with unhealthy lifestyles,” Liu said. “Given that large proportions of subjects suffering from poor sleep quality are underdiagnosed and undertreated, our study calls for more research into this field and strategies to improve sleep quality.”

This study, “Sleep Factors in Relation to Metabolic-Dysfunction Associated Fatty Liver Disease in Middle-Aged and Elderly Chinese,” was published in the Journal of Clinical Endocrinology and Metabolism.