Sleep Duration, Sleep Quality, and the Development of Nonalcoholic Fatty Liver Disease: A Cohort Study - PubMed (original) (raw)

Sleep Duration, Sleep Quality, and the Development of Nonalcoholic Fatty Liver Disease: A Cohort Study

Yoo Jin Um et al. Clin Transl Gastroenterol. 2021.

Abstract

Introduction: The longitudinal relationship between sleep duration, sleep quality, and the risk of nonalcoholic fatty liver disease (NAFLD) is unknown. We aimed to examine the association between sleep duration, sleep quality, and NAFLD development.

Methods: Using the Pittsburgh Sleep Quality Index, sleep duration and quality were evaluated for 143,306 NAFLD-free Korean adults with a mean age of 36.6 years, who were followed for an average of 4.0 years. Hepatic steatosis (HS) was assessed using ultrasonography and liver fibrosis by the fibrosis-4 index (FIB-4) or the NAFLD fibrosis score. Flexible parametric proportional hazard models were used to determine the hazard ratios (HRs) and 95% confidence intervals.

Results: There were 27,817 subjects with incident HS, of whom 1,471 had incident HS plus intermediate/high FIB-4. Multivariable-adjusted HRs (95% confidence intervals) for incident HS comparing sleep durations of ≤5, 6, 8, and ≥ 9 hours with 7 hours were 1.19 (1.14-1.23), 1.07 (1.04-1.10), 0.98 (0.94-1.02), and 0.95 (0.87-1.03), respectively. The corresponding HRs for incident HS plus intermediate/high FIB-4 were 1.30 (1.11-1.54), 1.14 (1.01-1.29), 1.11 (0.93-1.33), and 1.08 (0.71-1.63). The association between sleep duration and HS plus intermediate/high FIB-4 was inverse in individuals with good sleep quality but tended to be U-shaped in those with poor sleep quality. The results were similar if FIB-4 was replaced by the NAFLD fibrosis score.

Discussion: In young adults, short sleep duration was independently associated with an increased risk of incident NAFLD with or without intermediate/high fibrosis score, suggesting a role for inadequate sleep quantity in NAFLD risk and severity.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

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Conflict of interest statement

Guarantor of the article: Seungho Ryu, MD, PhD, and Yoosoo Chang, MD, PhD.

Specific author contributions: Y.J.U: drafting of the manuscript and critical revision of the manuscript. Y.C: study concept and design; acquisition of data; interpretation of data; drafting of the manuscript; and critical revision of the manuscript. H.S.J: acquisition of data; interpretation of data; and critical revision of the manuscript. I.Y.C: interpretation of data and critical revision of the manuscript. J.H.S: technical or material support and study supervision. H.S: technical or material support and study supervision. S.H.W: interpretation of data and critical revision of the manuscript. C.D.B: interpretation of data and critical revision of the manuscript. S.R: study concept and design; acquisition of data; analysis and interpretation of data; and critical revision of the manuscript.

Financial support: None to report.

Potential competing interests: None to report.

Figures

Figure 1.

Figure 1.

Flowchart of the included subjects.

Figure 2.

Figure 2.

Multivariable-adjusted HRs for NAFLD. The curves represent adjusted HRs for incident NAFLD based on restricted cubic splines with knots at the 5th, 27.5th, 50th, 72.5th, and 95th percentiles of sleep duration distribution. The model was adjusted for age, sex, center, year of the screening examination, body mass index, alcohol consumption, smoking, physical activity, total energy intake, marital status, season, education level, depression, history of diabetes, and history of hypertension. HR, hazard ratio.

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