Association between chronotype and metabolic-associated fatty liver disease in employed adults: A longitudinal study in Southwestern China

ABSTRACT

The circadian system is an essential physiological regulator of mammals, and sleep chronotype may be associated with the risk of metabolic disorders. However, evidence regarding the role of sleep chronotype in the development of metabolic-associated fatty liver disease (MAFLD) is scarce, particularly in employed adults. We conducted a longitudinal study of 1,309 employed adults in Southwestern China with a five-year follow-up from 2017 to 2021. MAFLD was assessed by the presence of hepatic steatosis using abdominal ultrasonography, overweight/obese status, diabetes mellitus, metabolic dysregulation, or elevation of high-sensitivity C-reactive protein. Chronotype was assessed by the Morning and Evening Questionnaire-5 (MEQ-5). The logistic random effects model was applied to analyze the 5-year panel data to estimate the association between chronotype and MAFLD, and the potential effect modification of demographics on such association. The MAFLD prevalence of participants was 38.6% at baseline and showed an increasing trend during follow-up (p for trends < 0.05). Compared with morning chronotype, evening chronotype was positively associated with MAFLD (OR = 2.19, 95%CI: [1.09, 4.40]) after controlled for covariates. Age, sex, ethnicity, and educational level did not modify the association between chronotype and MAFLD. These findings suggest that improving circadian rhythms could reduce the risk of MAFLD and chronic disease burden among employed adults.

KEYWORDS:

• Chronotype
• MAFLD
• employed adults
• longitudinal study
• logistic random effects model

Acknowledgments

We are particularly grateful to the participants. We also thank all staff involved in this study for their painstaking efforts in conducting the data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

All authors made substantial contributions to the intellectual content of the paper and approved the final version of the manuscript. Conception and design: Shujuan Yang and Peng Jia. Data acquisition: Bo Yang, Honglian Zeng, Shujuan Yang. Statistical analysis and interpretation: Yao Fu, Bin Yu, Bo Yang, Jia Pan. Manuscript draft: Fu Yao, Bin Yu. Critical revision of the manuscript for intellectual content: Bo Yang, Chuanteng Feng, Jia Pan, Honglian Zeng, Peng Jia, Shujuan Yang. Funding obtainment: Shujuan Yang. Study supervision: Shujuan Yang and Peng Jia.

Data availability statement

The data supporting this study’s findings are available from the corresponding author upon reasonable request.

Ethical approval and consent to participate

The ethical approval of this study was received from the Ethics Committee of Clinical Medical College & Affiliated Hospital of Chengdu University (PJ 2019-015-02).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was supported by the National Key R&D Program of China (2023YFC3604702), “0 to 1” Innovation Research Project of Sichuan University (2023CX21), National Natural Science Foundation of China (42271433), Key R&D Project of Sichuan Province (2023YFS0251), Renmin Hospital of Wuhan University (JCRCYG-2022-003), Jiangxi Provincial 03 Special Foundation and 5G Program (20224ABC03A05), Wuhan University Specific Fund for Major School-level Internationalization Initiatives (WHU-GJZDZX-PT07), and the International Institute of Spatial Lifecourse Health (ISLE).