Poor Sleep Raises Risk for Fatty Liver Disease


Sleep behaviors, both alone and in combination, are associated with an increased risk of metabolic dysfunction-associated fatty liver disease (MAFLD), a Chinese analysis shows, which suggests the effect may be independent of obesity.

Yang Liu, PhD, from the School of Public Health at Sun Yat-sen University in Guangzhou, China, and colleagues studied data from more than 5,000 people who reported sleep behavior and underwent liver ultrasound.

Late bedtime, snoring, and long daytime naps were significantly associated with MAFLD, increasing risk by 37%, 59%, and 17%, respectively, while people with poor nighttime sleep and long daytime naps had “the highest risk of developing obesity.” “. liver disease,” Liu said in a press release.


In contrast, any of the six sleep patterns reduced risk by 16% each, and even “moderate improvement in sleep quality was associated with a 29% reduction in risk of fatty liver disease,” he added.

The study, published July 28 in the Journal of Clinical Endocrinology and Metabolism, also found that obesity accounts for only a fifth of the impact sleep quality has on MAFLD risk.

The rise of unhealthy lifestyle leads to an increase in MAFLD

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The authors write that MAFLD is “the leading chronic liver disease worldwide”, affecting about a quarter of the adult population, and can lead to end-stage liver disease and extrahepatic complications, which “represents a major health and economic burden”.

What’s more, the prevalence of the disease is “growing at an unforeseen rate,” rising from 18% to 29% in China over the past decade due to a “rapid increase in unhealthy lifestyles,” the authors note.

The authors report that sleep disturbance is becoming more common, “and causes multiple metabolic disorders”, for example, insomnia and habitual snoring are positively correlated with hypertension, impaired glucose metabolism and dyslipidemia.


However, it remains unclear whether sleep quality, which includes “several metabolic-related sleep behaviors,” represents an independent risk of MAFLD “over and over” from obesity.

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For further study, the researchers examined data from the baseline survey of the South China Prospective Cohort Study, which was conducted in four regions of South China and included 5,430 people aged 30-79 years.

Between March 2018 and October 2019, participants self-reported their sleep behavior using the Pittsburgh Sleep Quality Index and underwent liver ultrasound.


MAFLD was diagnosed in patients with hepatic steatosis and one of the following:

  • Overweight/obesity, defined in this study as body mass index ≥23 kg/m2

  • Presence of diabetes

  • Evidence for metabolic dysregulation

After excluding patients with insufficient data, as well as patients with cirrhosis of the liver, hepatectomy or liver cancer in anamnesis, among others, the group included 5011 people with a mean age of 64 years and a mean body mass index of 24.31 kg/m2. Forty percent were men.

Obesity was present in 13% of participants, while 15% had diabetes, 58% had hypertension, and 35% had metabolic syndrome.


MAFLD was diagnosed in 28% of the study population. They were older, were more likely to be college-educated women, and had a higher prevalence of pre-existing metabolic disorders and worse metabolic profiles than those who did not have the disease.

Addressing the association between sleep and risk of MAFLD, the researchers say that “in contrast to previous reports, neither shorter nor longer sleep duration was associated with risk of MAFLD.”

However, after adjusting for demographics, lifestyle, medication, and preexisting metabolic comorbidities, including hypertension, diabetes, and obesity, they found that the risk of FAFLD was significantly associated with late bedtime (defined as after 10 p.m.). ) with an odds ratio of 1.37 (P). < 0.05).

MAFLD was also associated with snoring with an odds ratio of 1.59 and with naps greater than 30 minutes with an odds ratio of 1.17 (P<0.05 for both).

When the team compared low- and high-risk sleep factors, they found that participants who went to bed early, slept 7-8 hours a night, never or rarely had insomnia or snoring, had infrequent daytime sleepiness and half their daytime sleep. -hour or less had an odds ratio for MAFLD versus other participants of 0.64 (P < 0.05).

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Combining these factors into a healthy sleep score, the team found that each additional increase in healthy sleep score was associated with a fully adjusted MAFLD odds ratio of 0.84 (P<0.05).

In contrast, people with poor nighttime sleep patterns and long daytime naps had a higher risk of developing MAFLD compared to people with healthy nighttime sleep patterns and half an hour of naps or less, with an odds ratio of 2.38 (P < 0.05). .

Further analysis showed that people with a sedentary lifestyle and central obesity had a higher risk of MAFLD, but the presence of obesity accounted for only 20.8% of the overall effect of sleep quality on the risk of MAFLD.

“Taken together, our results suggest that obesity only partially mediates the effect of overall sleep quality on MAFLD,” the authors write.

“Given that a large proportion of subjects suffering from poor sleep quality are not diagnosed or treated, our study requires more research in this area and strategies to improve sleep quality,” Liu said.

The study was supported by China’s “National Key Research and Development Program”, Funds for Basic Research of Central Universities (Sun Yat-sen University), Guangdong Provincial Natural Science Foundation, Guangzhou Medical Sciences Key Project, and Fund for Basic Research. Guangzhou Key Laboratory Project.

The authors report no relevant financial relationships.

J Clin Endocrinol Metab. Posted online July 28, 2022 Abstract

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