Circadian Misalignment Rather Than Sleep Duration is Associated with MAFLD: A Population-Based Propensity Score-Matched Study
Received 4 November 2020
Accepted for publication 15 January 2021
Published 29 January 2021 Volume 2021:13 Pages 103—111
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Steven A Shea
Zhiyuan Weng,1 Weijie Ou,2 Jiaofeng Huang,2 Medha Singh,3 Mingfang Wang,2 Yueyong Zhu,2 Rahul Kumar,4,* Su Lin2,*
1Cardiology Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, People’s Republic of China; 2Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People’s Republic of China; 3Department of General Medicine, Tan Tock Seng Hospital 308433, Singapore; 4Department of Gastroenterology and Hepatology, Duke-NUS Academic Medical Centre, Changi General Hospital 529889, Singapore
*These authors contributed equally to this work
Correspondence: Su Lin
Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou, Fujian 350001, People’s Republic of China
Background and Aims: Circadian misalignment (CM) leads to metabolic disorder. Metabolic (dysfunction) associated fatty liver disease (MAFLD) is a novel definition for fatty liver disease that requires the presence of metabolic dysfunction. As the association between CM and MAFLD remains unclear, this study is designed to explore whether there is an association between CM and MAFLD.
Methods: NHANES 2017– 2018 database was used in this study. Liver steatosis and fibrosis were diagnosed by Fibroscan®. CM was defined by the presence of mistimed sleep, late sleep or irregular chronotype. Propensity score matching (PSM) was used to match subjects for their age and gender.
Results: A total of 4552 participants were included in the study, with 2089 (45.89%) identified as MAFLD and 894 (19.64%) as CM. Participants with CM were significantly younger than those without (46.06 ± 18.06 vs 50.93 ± 17.78, p< 0.001). PSM for age and gender resulted in 894 participants with CM and 892 with non-CM. CM group had higher body mass index, liver enzymes, glucose and lipid levels. The prevalence of MAFLD was higher in the CM group than the non-CM group (45.41% vs 28.48%, p< 0.001). The presence of CM increased the risk of MAFLD by more than twofold. Short sleep duration (< 6 hours) was not independently associated with MAFLD or fibrosis if additionally adjusting for CM.
Conclusion: CM is independently associated with MAFLD, while short sleep duration (< 6 hours) is not an independent risk factor for MAFLD or liver fibrosis after adjusting for CM.
Keywords: fatty liver disease, MAFLD, circadian, sleep, fibrosis
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