Poor sleep quality ID’d as key risk factor for fatty liver disease
Chances of MASLD also linked to less physical activity in Chinese study
Poor sleep quality — noted by researchers as increasingly common in modern society — is significantly linked to a higher chance of having metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease, according to a new study from China, where the condition’s prevalence has increased by more than 10% in less than a decade.
The population-based study also found that the detrimental impact of poor sleep quality on MASLD frequency was further exacerbated among participants with greater physical inactivity.
While improving sleep quality was found to reduce the chances of MASLD regardless of physical activity levels, “engaging in PA [physical activity] well above current guidelines did not adequately counteract the adverse impacts of poor sleep on [MASLD],” the researchers noted.
These findings emphasize not only how “the current lower threshold recommended by the PA guidelines is insufficient to mitigate the harmful association between poor sleep and [MASLD],” but also the need for “inclusion of sleep in the current lifestyle intervention strategies for [MASLD],” the researchers wrote.
Their study, “Joint association of sleep quality and physical activity with metabolic dysfunction-associated fatty liver disease: a population-based cross-sectional study in Western China,” was published in the journal Nutrition & Diabetes.
MASLD prevalence in China rose to 35.6% in 2017
MASLD, also sometimes called metabolic dysfunction-associated fatty liver disease or MAFLD, is marked by the accumulation of fatty deposits in the liver among people who have underlying metabolic conditions like diabetes or high blood fat levels.
Over time, the condition can lead to liver damage and liver failure. To help slow or prevent disease progression, patients are generally encouraged to make lifestyle changes, such as improving their diet and increasing the amount of exercise they get.
Globally, MASLD is a public health concern, affecting nearly one-quarter of the adult population worldwide. In China, MASLD prevalence has risen from 22.8% in 2009 to 35.6% in 2017, the researchers noted.
“Physical inactivity and poor sleep quality, two major lifestyle behaviors increasingly prevalent in modern societies, have been found to be adversely associated with various metabolic dysfunctions,” including MASLD, the scientists wrote.
However, the potential joint effect of physical activity and sleep quality on MASLD frequency remains largely unknown.
To learn more, the team, led by researchers at the First Affiliated Hospital of Xinjiang Medical University, analyzed data from 10,089 adults participating in a population-based study of chronic diseases in Western China between 2019 and 2021. The participants’ mean age was 47, and slightly more than half (51.6%) were men. Among them, 3,854 (38.2%) were diagnosed with MASLD.
All completed an initial survey in which they reported their sleep quality and physical activity, and each subsequently underwent several liver scans over time.
Sleep behaviors were assessed with the Pittsburgh Sleep Quality Index questionnaire. Several domains, such as bedtimes and night sleep duration, where less than seven hours per day was considered short, were combined into a composite score. That score also included daytime napping, which is common in China.
The composite score ranged from zero to six, with a score of two or lower being classified as poor sleep, 3-4 as intermediate, and five or higher as good sleep.
Physical activity was assessed using the International Physical Activity Questionnaire, and then scored by multiplying metabolic equivalent (MET) values, or the energy used in specific levels of physical activity, as determined by the weekly duration of such activities in hours.
Specifically, physical activity was categorized as low (below 600 MET multiplied by minutes per week, min/week), moderate (600-3,000 MET multiplied by min/week), and high (over 3,000 MET multiplied by min/week).
More than 1 in 10 study participants found to have poor sleep quality
The results showed that about a quarter of participants (26.1%) had good sleep, while 60.7% had intermediate sleep and 13.2% had poor sleep. Most participants engaged in moderate physical activity (65.9%), with slightly more than 1 in 10 (12.3%) found to have high physical activity.
Most participants (79.2%) failed to meet the physical activity recommendation of the World Health Organization (WHO), which calls for at least 150 minutes (2.5 hours) of moderate physical activity or at least 75 minutes (1.25 hours) of vigorous physical activity, or equivalent combinations of both, per week.
Poor sleep and physical inactivity were independently associated with a significantly higher prevalence of MASLD, even after adjusting for potential influencing factors, such as age, smoking status, alcohol drinking, sedentary time, diet diversity, and body mass index, which is a ratio of height and weight.
The data showed that poor sleep was linked to a 45% higher likelihood of MASLD relative to good sleep, while low physical activity was associated with a 37% higher likelihood compared with high activity volume.
Failure to meet the WHO’s activity recommendation significantly increased the chances of having MASLD, by 37%.
Public health awareness and strategies concurrently targeting both sleep quality and [physical activity] should be encouraged to curb the climbing prevalence of MAFLD.
In addition, the smallest chance of having MASLD was observed among participants with good sleep and high activity levels, while the highest chance — by nearly three times — was seen among those with poor sleep and medium activity levels.
Across all levels of physical activity, good or intermediate sleep quality was linked with a lower MASLD prevalence. Poor sleep increased the chances of having MASLD by about twofold in people with high physical activity and those meeting WHO recommendations.
These findings suggest that engaging in high physical activity or reaching the recommended activity levels “seemed not sufficient enough to attenuate the detrimental effects of poor sleep on MAFLD,” the researchers wrote.
Overall, “public health awareness and strategies concurrently targeting both sleep quality and PA should be encouraged to curb the climbing prevalence of MAFLD,” the researchers concluded.
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