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Late bedtime and risk of fatty liver disease

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Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India; Dr Joel Teelucksingh, Dept, of Endocrinology, San Fernando General Hospital & Central Specialist Medical Centre, Chaguanas, Trinidad &Tobago    01 August 2022

Poor sleep behaviors such as sleeping late, snoring and excessive daytime napping are associated with increased risk for metabolic-dysfunction associated fatty liver disease (MAFLD), says a new study from China reported in the Journal of Clinical Endocrinology & Metabolism.1

Researchers analysed the link between self-reported sleep behavior with MAFLD in 5011 participants with fatty liver disease in this cross-sectional study. Data was sourced from the community-based, prospective South China Cohort study. The Pittsburgh Sleep Quality Index questionnaire was used to gather information from the participants about their sleep behavior from March 2018 to October 2019. Patients with hepatic steatosis and the presence of any one of the following: Diabetes, overweight/obesity (≥23 kg/m2) and evidence of metabolic dysregulation.2 A healthy sleep score was calculated to determine this association. The average age of the participants was 64 years and the BMI was 24.31 kg/m2 (mean).

Fifteen percent of the study subjects were diabetic, while 13% were obese, 58% were hypertensive and 35% had metabolic syndrome. Twenty-eight percent of them had MAFLD.

Sleeping late at night was associated with 37% increased risk of MAFLD with odds ratios of 1.37. The risk was also elevated by 59% and 17% among those who snored and napped for more than 30 minutes during the day with ORs of 1.59 and 1.17, respectively. The highest risk was observed among those who had disruptive disrupted nighttime sleep and excessive daytime sleepiness (OR 2.38).

The study also found that for every additional increase in the healthy sleep score, the risk for MAFPD declined by 16% and the risk decreased further by 29% with even "a moderate improvement in sleep quality”. The adverse effects of sleep were more pronounced among the participants with central obesity and those with a sedentary lifestyle. The impact of obesity on the association of total effect of sleep quality and MAFLD risk was just 20%.

Adequate and good quality sleep is vital to overall health, both physical and mental. This study has added to the growing evidence about the association of poor sleep quality and adverse health effects such as MAFLD. Its importance can be gauged by the fact that the American Heart Association (AHA) recently added sleep as an essential component of its “Life’s Essential 8” for optimum cardiovascular health. This study also highlights MAFLD as an emerging public health problem and urges creating awareness among the general public and also appropriate policies to check the rising prevalence of MAFLD.

 References

  1. Jialu Yang, et al. Sleep factors in relation to metabolic-dysfunction associated fatty liver disease in middle-aged and elderly Chinese. J Clin Endocrinol Metab. 2022 Jul 28;dgac428. doi: 10.1210/clinem/dgac428.
  2. Poor sleep raises risk for fatty liver disease - Medscape - Jul 28, 2022.

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