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Wang W, Zhuang Z, Song Z, Zhao Y, Huang T. Sleep patterns, genetic predisposition, and risk of chronic liver disease: A prospective study of 408,560 UK Biobank participants. J Affect Disord 2024; 352:229-236. [PMID: 38199417 DOI: 10.1016/j.jad.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/27/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Little is known about the role that combined sleep behaviors play in the association with chronic liver disease (CLD) risk. METHODS We included 408,560 participants initially free of CLD from the UK Biobank. A healthy sleep pattern was defined by early chronotype, sleep duration of 7-8 h/day, no insomnia, no snoring, and no excessive daytime sleepiness. Cox regression models were used to examine the association of healthy sleep pattern with incident CLD and their interaction with PNPLA3 genetic risk. RESULTS During a median 12.5 years of follow-up, we documented 10,915 incident all-cause CLD cases, including 388 viral hepatitis, 4782 non-alcoholic fatty liver disease (NAFLD), 1356 cirrhosis, 973 alcoholic liver disease, and 725 liver cancer cases. Compared to participants with a healthy sleep score of 0-1, the hazard ratio (HR) (95 % confidence interval [CI]) for those with a sleep score of 5 was 0.54 (0.49, 0.60) for CLD, 0.52 (0.30, 0.90) for viral hepatitis, 0.47 (0.41, 0.55) for NAFLD, 0.57 (0.43, 0.75) for cirrhosis, 0.32 (0.23, 0.44) for alcoholic liver disease, and 0.53 (0.37, 0.77) for liver cancer. Healthy sleep pattern and PNPLA3 genetic risk exerted significant additive effects on CLD risk (relative excess risk due to the interaction: 0.05; attributable proportion due to the interaction: 13 %). LIMITATIONS Measurement error was unavoidable for self-reported data on sleep behaviors. CONCLUSIONS Our analyses provide evidence that healthy sleep pattern was inversely associated with the development of CLD, and participants with higher genetic risk were more likely to develop CLD when exposed to the unhealthy sleep pattern.
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Affiliation(s)
- Wenxiu Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhenhuang Zhuang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zimin Song
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yimin Zhao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China.
| | - Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China; Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, Beijing, China.
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Tang H, Lv F, Zhang P, Liu J, Mao J. The impact of obstructive sleep apnea on nonalcoholic fatty liver disease. Front Endocrinol (Lausanne) 2023; 14:1254459. [PMID: 37850091 PMCID: PMC10577417 DOI: 10.3389/fendo.2023.1254459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by episodic sleep state-dependent collapse of the upper airway, with consequent hypoxia, hypercapnia, and arousal from sleep. OSA contributes to multisystem damage; in severe cases, sudden cardiac death might occur. In addition to causing respiratory, cardiovascular and endocrine metabolic diseases, OSA is also closely associated with nonalcoholic fatty liver disease (NAFLD). As the prevalence of OSA and NAFLD increases rapidly, they significantly exert adverse effects on the health of human beings. The authors retrieved relevant documents on OSA and NAFLD from PubMed and Medline. This narrative review elaborates on the current knowledge of OSA and NAFLD, demonstrates the impact of OSA on NAFLD, and clarifies the underlying mechanisms of OSA in the progression of NAFLD. Although there is a lack of sufficient high-quality clinical studies to prove the causal or concomitant relationship between OSA and NAFLD, existing evidence has confirmed the effect of OSA on NAFLD. Elucidating the underlying mechanisms through which OSA impacts NAFLD would hold considerable importance in terms of both prevention and the identification of potential therapeutic targets for NAFLD.
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Affiliation(s)
- Haiying Tang
- Department of Respiratory and Critical Disease, Respiratory Sleep Disorder Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Furong Lv
- Department of Gastroenterology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Peng Zhang
- Department of Medical Information Engineering, Zhongshan College of Dalian Medical University, Dalian, Liaoning, China
| | - Jia Liu
- Department of Respiratory and Critical Disease, Respiratory Sleep Disorder Center, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jingwei Mao
- Department of Gastroenterology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Yang J, Zhang K, Xi Z, Ma Y, Shao C, Wang W, Tang YD. Short sleep duration and the risk of nonalcoholic fatty liver disease/metabolic associated fatty liver disease: a systematic review and meta-analysis. Sleep Breath 2023; 27:1985-1996. [PMID: 36544011 PMCID: PMC9771780 DOI: 10.1007/s11325-022-02767-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE It is unclear whether or not nonalcoholic fatty liver disease (NAFLD)/metabolic dysfunction-associated fatty liver disease (MAFLD) is related to short sleep duration. A meta-analysis was conducted to determine if inadequate sleep time increased the risk of NAFLD/MAFLD. METHODS A comprehensive systematic literature review was conducted in the Embase, PubMed, and Cochrane Library databases from inception to August 1, 2022. Studies examining the correlation between inadequate sleep time and the risk of NAFLD/MAFLD were included. We pooled the odds ratios (ORs) and 95% confidence intervals (CIs) using a random-effects model. RESULTS This meta-analysis included fifteen studies involving a total of 261,554 participants. In the pooled analysis, short sleep duration was found to be strongly correlated with an increased risk of NAFLD/MAFLD (OR, 1.15; 95% CI, 1.04-1.28; P = 0.01), with a moderate degree of heterogeneity between studies (I2 = 71.92%, Q = 49.87, P < 0.01). The sensitivity analysis suggested that the primary outcome was robust, and there was no significant publication bias. CONCLUSION This meta-analysis indicates that inadequate sleep duration is strongly correlated with an elevated risk of NAFLD/MAFLD. The findings suggest that obtaining an adequate amount of sleep may be useful for preventing NAFLD/MAFLD, which is especially important given the low rate of response to pharmacotherapy.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China
| | - Ziwei Xi
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037 China
| | - Yue Ma
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No. 49 Huayuanbei Road, Beijing, 100191 China
| | - Chunli Shao
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No. 49 Huayuanbei Road, Beijing, 100191 China
| | - Wenyao Wang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No. 49 Huayuanbei Road, Beijing, 100191 China
| | - Yi-Da Tang
- Department of Cardiology and Institute of Vascular Medicine, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, No. 49 Huayuanbei Road, Beijing, 100191 China
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Sun Z, Ji J, Zuo L, Hu Y, Wang K, Xu T, Wang Q, Cheng F. Causal relationship between nonalcoholic fatty liver disease and different sleep traits: a bidirectional Mendelian randomized study. Front Endocrinol (Lausanne) 2023; 14:1159258. [PMID: 37334291 PMCID: PMC10272397 DOI: 10.3389/fendo.2023.1159258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Background and aims Non-alcoholic fatty liver disease(NAFLD) is common worldwide and has previously been reported to be associated with sleep traits. However, it is not clear whether NAFLD changes sleep traits or whether the changes in sleep traits lead to the onset of NAFLD. The purpose of this study was to investigate the causal relationship between NAFLD and changes in sleep traits using Mendelian randomization. Methods We proposed a bidirectional Mendelian randomization (MR) analysis and performed validation analyses to dissect the association between NAFLD and sleep traits. Genetic instruments were used as proxies for NAFLD and sleep. Data of genome-wide association study(GWAS) were obtained from the center for neurogenomics and cognitive research database, Open GWAS database and GWAS catalog. Three MR methods were performed, including inverse variance weighted method(IVW), MR-Egger, weighted median. Results In total,7 traits associated with sleep and 4 traits associated with NAFLD are used in this study. A total of six results showed significant differences. Insomnia was associated with NAFLD (OR(95% CI)= 2.25(1.18,4.27), P = 0.01), Alanine transaminase levels (OR(95% CI)= 2.79(1.70, 4.56), P =4.71×10-5) and percent liver fat(OR(95% CI)= 1.31(1.03,1.69), P = 0.03). Snoring was associated with percent liver fat (1.15(1.05,1.26), P =2×10-3), alanine transaminase levels (OR(95% CI)= 1.27(1.08,1.50), P =0.04).And dozing was associated with percent liver fat(1.14(1.02,1.26), P =0.02).For the remaining 50 outcomes, no significant or definitive association was yielded in MR analysis. Conclusion Genetic evidence suggests putative causal relationships between NAFLD and a set of sleep traits, indicating that sleep traits deserves high priority in clinical practice. Not only the confirmed sleep apnea syndrome, but also the sleep duration and sleep state (such as insomnia) deserve clinical attention. Our study proves that the causal relationship between sleep characteristics and NAFLD is the cause of the change of sleep characteristics, while the onset of non-NAFLD is the cause of the change of sleep characteristics, and the causal relationship is one-way.
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Kyle Martin W, Schladweiler MC, Oshiro W, Smoot J, Fisher A, Williams W, Valdez M, Miller CN, Jackson TW, Freeborn D, Kim YH, Davies D, Ian Gilmour M, Kodavanti U, Kodavanti P, Hazari MS, Farraj AK. Wildfire-related smoke inhalation worsens cardiovascular risk in sleep disrupted rats. FRONTIERS IN ENVIRONMENTAL HEALTH 2023; 2:1166918. [PMID: 38116203 PMCID: PMC10726696 DOI: 10.3389/fenvh.2023.1166918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Introduction As a lifestyle factor, poor sleep status is associated with increased cardiovascular morbidity and mortality and may be influenced by environmental stressors, including air pollution. Methods To determine whether exposure to air pollution modified cardiovascular effects of sleep disruption, we evaluated the effects of single or repeated (twice/wk for 4 wks) inhalation exposure to eucalyptus wood smoke (ES; 964 μg/m3 for 1 h), a key wildland fire air pollution source, on mild sleep loss in the form of gentle handling in rats. Blood pressure (BP) radiotelemetry and echocardiography were evaluated along with assessments of lung and systemic inflammation, cardiac and hypothalamic gene expression, and heart rate variability (HRV), a measure of cardiac autonomic tone. Results and Discussion GH alone disrupted sleep, as evidenced by active period-like locomotor activity, and increases in BP, heart rate (HR), and hypothalamic expression of the circadian gene Per2. A single bout of sleep disruption and ES, but neither alone, increased HR and BP as rats transitioned into their active period, a period aligned with a critical early morning window for stroke risk in humans. These responses were immediately preceded by reduced HRV, indicating increased cardiac sympathetic tone. In addition, only sleep disrupted rats exposed to ES had increased HR and BP during the final sleep disruption period. These rats also had increased cardiac output and cardiac expression of genes related to adrenergic function, and regulation of vasoconstriction and systemic blood pressure one day after final ES exposure. There was little evidence of lung or systemic inflammation, except for increases in serum LDL cholesterol and alanine aminotransferase. These results suggest that inhaled air pollution increases sleep perturbation-related cardiovascular risk, potentially in part by increased sympathetic activity.
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Affiliation(s)
- W. Kyle Martin
- Curriculum in Toxicology and Environmental Medicine, UNC, Chapel Hill, NC, United States
| | - M. C. Schladweiler
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - W. Oshiro
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - J. Smoot
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - A. Fisher
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - W. Williams
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. Valdez
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - C. N. Miller
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - T. W. Jackson
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - D. Freeborn
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - Y. H. Kim
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - D. Davies
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. Ian Gilmour
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - U. Kodavanti
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - P. Kodavanti
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - M. S. Hazari
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
| | - A. K. Farraj
- Public Health & Integrated Toxicology Division, US EPA, Research Triangle Park, NC, United States
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Adori M, Bhat S, Gramignoli R, Valladolid-Acebes I, Bengtsson T, Uhlèn M, Adori C. Hepatic Innervations and Nonalcoholic Fatty Liver Disease. Semin Liver Dis 2023; 43:149-162. [PMID: 37156523 PMCID: PMC10348844 DOI: 10.1055/s-0043-57237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder. Increased sympathetic (noradrenergic) nerve tone has a complex role in the etiopathomechanism of NAFLD, affecting the development/progression of steatosis, inflammation, fibrosis, and liver hemodynamical alterations. Also, lipid sensing by vagal afferent fibers is an important player in the development of hepatic steatosis. Moreover, disorganization and progressive degeneration of liver sympathetic nerves were recently described in human and experimental NAFLD. These structural alterations likely come along with impaired liver sympathetic nerve functionality and lack of adequate hepatic noradrenergic signaling. Here, we first overview the anatomy and physiology of liver nerves. Then, we discuss the nerve impairments in NAFLD and their pathophysiological consequences in hepatic metabolism, inflammation, fibrosis, and hemodynamics. We conclude that further studies considering the spatial-temporal dynamics of structural and functional changes in the hepatic nervous system may lead to more targeted pharmacotherapeutic advances in NAFLD.
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Affiliation(s)
- Monika Adori
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Sadam Bhat
- Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Roberto Gramignoli
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ismael Valladolid-Acebes
- Department of Molecular Medicine and Surgery, The Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska Institutet, Stockholm, Sweden
| | - Tore Bengtsson
- Department of Molecular Biosciences, The Wenner-Gren Institute (MBW), Stockholm University, Stockholm, Sweden
| | - Mathias Uhlèn
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Royal Institute of Technology, Stockholm, Sweden
| | - Csaba Adori
- Department of Molecular Biosciences, The Wenner-Gren Institute (MBW), Stockholm University, Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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de Assis LVM, Demir M, Oster H. The role of the circadian clock in the development, progression, and treatment of non-alcoholic fatty liver disease. Acta Physiol (Oxf) 2023; 237:e13915. [PMID: 36599410 DOI: 10.1111/apha.13915] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/25/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
The circadian clock comprises a cellular endogenous timing system coordinating the alignment of physiological processes with geophysical time. Disruption of circadian rhythms has been associated with several metabolic diseases. In this review, we focus on liver as a major metabolic tissue and one of the most well-studied organs with regard to circadian regulation. We summarize current knowledge about the role of local and systemic clocks and rhythms in regulating biological functions of the liver. We discuss how the disruption of circadian rhythms influences the development of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). We also critically evaluate whether NAFLD/NASH may in turn result in chronodisruption. The last chapter focuses on potential roles of the clock system in prevention and treatment of NAFLD/NASH and the interaction of current NASH drug candidates with liver circadian rhythms and clocks. It becomes increasingly clear that paying attention to circadian timing may open new avenues for the optimization of NAFLD/NASH therapies and provide interesting targets for prevention and treatment of these increasingly prevalent disorders.
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Affiliation(s)
| | - Münevver Demir
- Department of Hepatology and Gastroenterology, Charité University Medicine Berlin, Berlin, Germany
| | - Henrik Oster
- Institute of Neurobiology, Center of Brain Behavior & Metabolism, University of Lübeck, Lübeck, Germany
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Liu H, Huang S, Xu M, Zhao D, Wang X, Zhang L, Chen D, Du J, Yu R, Li H, Ye H. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study. Open Med (Wars) 2023; 18:20230670. [PMID: 36950534 PMCID: PMC10025511 DOI: 10.1515/med-2023-0670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/14/2023] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
Sleep can affect nonalcoholic fatty liver disease (NAFLD). We investigated the association between sleep duration, sleep quality, and NAFLD. From January to December 2018, 1,073 patients (age: 37.94 ± 10.88, Body Mass Index (BMI): 22.85 ± 3.27) were enrolled. Pittsburgh Sleep Quality Index Questionnaire and Munich Chronotype Questionnaire were used to assess sleep duration, quality, and habits. Ultrasonography was used to diagnose NAFLD. Multivariate logistic regression models were used to calculate the odds ratio (OR) and 95% confidence interval (CI) of the risk of NAFLD by different types of sleep duration and sleep quality. No significant differences in sleep time, sleep quality, and sleep habits between the NAFLD and the non-NAFLD groups were observed (P > 0.05). There was no correlation between sleep duration and NAFLD in the whole cohort. After adjusting for age, exercise, fasting plasma glucose, and BMI, the group with long sleep duration showed a decreased risk of NAFLD in men (OR = 0.01, 95% CI: 0.001-0.27, P = 0.032). However, in all four adjusted models, no correlation between sleep duration, quality, and NAFLD was found in women. In conclusion, sleep duration was significantly and negatively associated with NAFLD in men but not women. Prospective studies are required to confirm this association.
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Affiliation(s)
- Huiwei Liu
- Department of Gastroenterology, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
| | - Shiliang Huang
- Department of Gastroenterology, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
| | - Mengdan Xu
- Department of Gastroenterology, Cixi People’s Hospital, Cixi, Zhejiang 315300, P.R. China
| | - Dan Zhao
- Department of Gastroenterology, Cixi People’s Hospital, Cixi, Zhejiang 315300, P.R. China
| | - Xinxue Wang
- School of Medicine, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
| | - Liangshun Zhang
- Department of Gastroenterology, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
| | - Dahua Chen
- Department of Gastroenterology, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
| | - Jinman Du
- Physical Examination Center, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
| | - Rongbin Yu
- Department of Preventation and Care, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
| | - Hong Li
- Department of Hepatobiliary Surgery, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, 315040, P.R. China
| | - Hua Ye
- Department of Gastroenterology, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang 315040, P.R. China
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Taleb Z, Karpowicz P. Circadian regulation of digestive and metabolic tissues. Am J Physiol Cell Physiol 2022; 323:C306-C321. [PMID: 35675638 DOI: 10.1152/ajpcell.00166.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The circadian clock is a self-sustained molecular timekeeper that drives 24-h (circadian) rhythms in animals. The clock governs important aspects of behavior and physiology including wake/sleep activity cycles that regulate the activity of metabolic and digestive systems. Light/dark cycles (photoperiod) and cycles in the time of feeding synchronize the circadian clock to the surrounding environment, providing an anticipatory benefit that promotes digestive health. The availability of animal models targeting the genetic components of the circadian clock has made it possible to investigate the circadian clock's role in cellular functions. Circadian clock genes have been shown to regulate the physiological function of hepatocytes, gastrointestinal cells, and adipocytes; disruption of the circadian clock leads to the exacerbation of liver diseases and liver cancer, inflammatory bowel disease and colorectal cancer, and obesity. Previous findings provide strong evidence that the circadian clock plays an integral role in digestive/metabolic disease pathogenesis, hence, the circadian clock is a necessary component in metabolic and digestive health and homeostasis. Circadian rhythms and circadian clock function provide an opportunity to improve the prevention and treatment of digestive and metabolic diseases by aligning digestive system tissue with the 24-h day.
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Affiliation(s)
- Zainab Taleb
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
| | - Phillip Karpowicz
- Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada
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Zhou J, Long Y, Ding N, Su Y. Association between bedtime at night and nonalcoholic fatty liver disease diagnosed by liver ultrasound transient elastography. Diabetes Res Clin Pract 2022; 184:109195. [PMID: 35033597 DOI: 10.1016/j.diabres.2022.109195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to explore the association between bedtime at night and nonalcoholic fatty liver disease (NAFLD) measured by liver ultrasound transient elastography (LUTE). METHODS A total of 4572 individuals were included. The diagnosis of NAFLD was based on the controlled attenuated parameter (CAP) score of LUTE. CAP score ≥ 263 dB/m and CAP score ≥ 285 dB/m were used as the criterions for the diagnosis of NAFLD. RESULTS For the weekday bedtime, a positive association was identified in CAP (263 dB/m) (OR, 1.04 [95 %CI, 0.99, 1.09]) and CAP (285 dB/m) (OR, 1.00 [95 %CI, 0.95, 1.05]). For the weekend bedtime, a positive relationship was found in CAP (263 dB/m) (OR, 1.05 [95 %CI, 1.00, 1.10]). The positive relationship still presented in CAP (285 dB/m) (OR, 1.05[95 %CI, 1.00, 1.10]). When NAFLD defined as CAP score ≥ 263 dB/m, the relationship between weekday bedtime and NAFLD was a straight line. For the weekend bedtime, the association was nonlinear. Before 22:00 o'clock, the association was positive (OR, 1.26 [95 %CI, 1.06, 1.50]), while between 22:00 and 1:00 o'clock, the relationship was negative (OR, 0.96 [95 %CI, 0.88, 1.05]) without a significant P value. After 1:00o'clock, the relationship was positive (OR, 1.26 [95 %CI, 1.02, 1.57]). CONCLUSION Later bedtime was positive associated with NAFLD.
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Affiliation(s)
- Junfeng Zhou
- Endoscopic Center & Ambulatory Surgery Center, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410000, China.
| | - Yong Long
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, China
| | - Ning Ding
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO.161 Shaoshan South Road, Changsha, Hunan 410004, China.
| | - Yingjie Su
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, NO.161 Shaoshan South Road, Changsha, Hunan 410004, China.
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11
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Fan H, Liu Z, Zhang X, Yuan H, Zhao X, Zhao R, Shi T, Wu S, Xu Y, Suo C, Chen X, Zhang T. Investigating the Association Between Seven Sleep Traits and Nonalcoholic Fatty Liver Disease: Observational and Mendelian Randomization Study. Front Genet 2022; 13:792558. [PMID: 35656325 PMCID: PMC9152285 DOI: 10.3389/fgene.2022.792558] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Aim: Aberrant sleep parameters are associated with the risk of nonalcoholic fatty liver disease (NAFLD). However, existing information is inconsistent among studies and involves reverse causation. Therefore, we aimed to investigate the observational associations and causations between sleep traits and NAFLD. Methods: We performed multivariable regression to assess observational associations of seven sleep traits (sleep duration, easiness of getting up in the morning, chronotype, nap during day, snoring, insomnia, and narcolepsy), and NAFLD in the UK Biobank (1,029 NAFLD). The Cox proportional hazards model was applied to derive hazard ratios and 95% confidence intervals (CIs). Furthermore, a bidirectional two-sample Mendelian randomization (MR) approach was used to explore the causal relationships between sleep traits and NAFLD. Results: In the multivariable regression model adjusted for potential confounders, getting up in the morning not at all easy (HR, 1.51; 95% CI, 1.27-1.78) and usually insomnia (HR, 1.46; 95% CI, 1.21-1.75) were associated with the risk of NAFLD. Furthermore, the easiness of getting up in the morning and insomnia showed a dose-response association with NAFLD (Ptrend <0.05). MR analysis found consistent causal effects of NAFLD on easiness of getting up in the morning (OR, 0.995; 95% CI, 0.990-0.999; p = 0.033) and insomnia (OR, 1.006; 95% CI, 1.001-1.011; p = 0.024). These results were robust to weak instrument bias, pleiotropy, and heterogeneity. Conclusions: Findings showed consistent evidence of observational analyses and MR analyses that trouble getting up in the morning and insomnia were associated with an increased risk of NAFLD. Bidirectional MR demonstrated causal effects of NAFLD on sleep traits.
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Affiliation(s)
- Hong Fan
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Zhenqiu Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China.,State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Huangbo Yuan
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Xiaolan Zhao
- Department of Chronic Diseases Prevention, Taizhou Center for Disease Control and Prevention, Jiangsu, China
| | - Renjia Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Tingting Shi
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Sheng Wu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Yiyun Xu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Chen Suo
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Xingdong Chen
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China.,State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China.,Department of Chronic Diseases Prevention, Taizhou Center for Disease Control and Prevention, Jiangsu, China.,Human Phenome Institute, Fudan University, Shanghai, China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.,Fudan University Taizhou Institute of Health Sciences, Taizhou, China
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12
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Li Q, Zhang S, Wang H, Xue C, Zhang X, Qin S, Yuan J. Rotating night shift work, sleep duration and elevated gamma-glutamyl transpeptidase among steelworkers: cross-sectional analyses from a Chinese occupational cohort. BMJ Open 2021; 11:e053125. [PMID: 34911716 PMCID: PMC8679064 DOI: 10.1136/bmjopen-2021-053125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the separate and combined effects of rotating night shift work and lifestyle factors with elevated gamma-glutamyl transpeptidase (GGT) among steelworkers. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study used the baseline information from a Chinese occupational cohort. The in-service workers of the production department of Tangsteel Company who participated in the occupational health examination in Tangshan from February to June 2017 were selected as the research objects. MAIN OUTCOME MEASURES The separate and combined effects of rotating night shift work and lifestyle factors with elevated GGT among steelworkers. RESULTS The information of 7031 subjects from the production department of Tangsteel Company was analysed. Results showed that the current shift workers and the workers with the duration of night shifts>19 years, the cumulative number of night shifts>1774 nights, the average frequency of night shifts≤7 nights/month and the average frequency of night shifts>7 nights/month had elevated odds of elevated GGT, compared with those who never worked night shifts, and ORs, (95% CIs) were 1.39, (1.10 to 1.75), 1.46, (1.15 to 1.86), 1.46, (1.15 to 1.85), 1.34, (1.04 to 1.73) and 1.37, (1.09 to 1.74) after adjustment for potential confounders. The independent effect of shorter sleep duration (<7 hours/day) on elevated GGT was not statistically significant. Among workers who had shorter sleep duration, the association between rotating night shift work and elevated GGT was statistically significant, but no associations were found among workers with the sleep duration of ≥7 hours/day. In addition, other lifestyle factors affected the association between rotating night shift work and elevated GGT. CONCLUSIONS Rotating night shift work is associated with elevated GGT among steelworkers. In particular, the effect of rotating night shift work on elevated GGT was affected by sleep duration and other lifestyle factors.
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Affiliation(s)
- Qinglin Li
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Shengkui Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Han Wang
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Chao Xue
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Xiaohong Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Sheng Qin
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Juxiang Yuan
- School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
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13
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Cerebrovascular alterations in NAFLD: Is it increasing our risk of Alzheimer's disease? Anal Biochem 2021; 636:114387. [PMID: 34537182 DOI: 10.1016/j.ab.2021.114387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a multisystem disease, which has been classified as an emerging epidemic not only confined to liver-related morbidity and mortality. It is also becoming apparent that NAFLD is associated with moderate cerebral dysfunction and cognitive decline. A possible link between NAFLD and Alzheimer's disease (AD) has only recently been proposed due to the multiple shared genes and pathological mechanisms contributing to the development of these conditions. Although AD is a progressive neurodegenerative disease, the exact pathophysiological mechanism remains ambiguous and similarly to NAFLD, currently available pharmacological therapies have mostly failed in clinical trials. In addition to the usual suspects (inflammation, oxidative stress, blood-brain barrier alterations and ageing) that could contribute to the NAFLD-induced development and progression of AD, changes in the vasculature, cerebral perfusion and waste clearance could be the missing link between these two diseases. Here, we review the most recent literature linking NAFLD and AD, focusing on cerebrovascular alterations and the brain's clearance system as risk factors involved in the development and progression of AD, with the aim of promoting further research using neuroimaging techniques and new mechanism-based therapeutic interventions.
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14
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Mikolasevic I, Domislovic V, Filipec Kanizaj T, Radic-Kristo D, Krznaric Z, Milovanovic T, Juric T, Klapan M, Skenderevic N, Delija B, Stevanovic T, Mijic A, Lukic A, Stimac D. Relationship between coffee consumption, sleep duration and smoking status with elastographic parameters of liver steatosis and fibrosis; controlled attenuation parameter and liver stiffness measurements. Int J Clin Pract 2021; 75:e13770. [PMID: 33070425 DOI: 10.1111/ijcp.13770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
AIM our aim was to explore the association between life habits and the controlled attenuation parameter (CAP) and liver stiffness measurements (LSM) as the surrogate markers of liver steatosis and fibrosis in a large cohort of non-alcoholic fatty liver disease (NAFLD) patients. METHODS In this prospective, cross-sectional study we had analysed 1998 patients with diagnosed NAFLD. Sleeping duration was categorised in three groups: short (S) (<6 hours), moderate (M) (6-8 hours) and long (L) (>8 hours) sleep duration. Coffee drinking was categorized into no (0), moderate (1-2) and frequent (≥3) consumption (in cups/day). Smoking was categorised as yes versus no. RESULTS Frequent coffee consumers had the lowest prevalence of obesity, hypertension, dyslipidaemia and diabetes. Furthermore, coffee non-consumers had highest values of hepatic enzymes, CAP and LSM. Moderate sleep duration was associated with lower values of CAP and LSM. Coffee consumption was associated with lower CAP in all the multivariate models (CAP unadjusted and model 1, 2 and 3), with largest effect in most frequent coffee consumers (≥3, model 3). Also, most frequent coffee consumers were associated with lower LSM in unadjusted model, model 1 and 2, while this was not the case for model 3 and those who consumed 1-2 cups of coffee per day. Reduced sleeping was confirmed as risk factor for elevated CAP in most of the models (unadjusted and model 1 and 2). Also, negative association of LSM was also confirmed in unadjusted model and model 2. Patients which slept 6-8 hours per day were mostly associated with lower CAP and LSM. Smoking status was not associated with CAP or LSM values. CONCLUSION Coffee consumption has beneficial effect on CAP and LSM and this effect is dose dependent since and independent of a variety of relevant confounders. We have shown that moderate sleep duration has also beneficial effect on CAP and LSM.
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Affiliation(s)
- Ivana Mikolasevic
- Department of Gastroenterology, University Hospital Centre Rijeka, Rijeka, Croatia
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Viktor Domislovic
- Department for Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tajana Filipec Kanizaj
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Delfa Radic-Kristo
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Hematology, University Hospital Merkur, Zagreb, Croatia
| | - Zeljko Krznaric
- Department for Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tamara Milovanovic
- School of Medicine, University of Belgrade Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Toni Juric
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Mia Klapan
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nadija Skenderevic
- Department of Gastroenterology, University Hospital Merkur, Zagreb, Croatia
| | - Bozena Delija
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | | | - Ana Mijic
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Andjela Lukic
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Davor Stimac
- Department of Gastroenterology, University Hospital Centre Rijeka, Rijeka, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
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15
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Luu HN, Behari J, Goh GBB, Wang R, Jin A, Thomas CE, Clemente JC, Odegaard AO, Koh WP, Yuan JM. Composite Score of Healthy Lifestyle Factors and Risk of Hepatocellular Carcinoma: Findings from a Prospective Cohort Study. Cancer Epidemiol Biomarkers Prev 2021; 30:380-387. [PMID: 33187965 PMCID: PMC7867589 DOI: 10.1158/1055-9965.epi-20-1201] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 11/09/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND While the associations between individual lifestyle factors and risk of hepatocellular carcinoma (HCC) have been described previously, their combined impact on HCC risk is unknown. METHODS The association of a composite score of healthy lifestyle factors, including body mass index, alcohol consumption, cigarette smoking, alternative Mediterranean diet, and sleep duration, and HCC risk was examined in the Singapore Chinese Health Study, an ongoing prospective cohort study of 63,257 Chinese men and women. Cox proportional hazard regression method was used to estimate HR and its 95% confidence interval (CI). Conditional logistic regression method was used to evaluate this composite lifestyle score-HCC risk association among a subset of individuals who tested negative for hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody. RESULTS After a mean follow-up of 17.7 years, 561 participants developed HCC. Individuals with higher composite scores representing healthier lifestyles (range 0-8) were at significantly lower risk of HCC. Compared with the lowest composite score category (0-4), the HRs (95% CIs) for the composite scores of 5, 6, 7, and 8 were 0.67 (0.62-0.85), 0.61 (0.48-0.77), 0.49 (0.37-0.65), and 0.13 (0.06-0.30), respectively (P trend < 0.0001). A similar inverse association was observed in participants with negative HBsAg and anti-hepatitis C virus (HCV)-negative serology (HR, 0.38; 95% CI, 0.19-0.79; for the highest vs. the lowest category of the composite scores; P trend = 0.001). CONCLUSIONS Healthy lifestyles protect against HCC development, especially for individuals without hepatitis B virus and HCV infections. IMPACT This study highlights the importance of a comprehensive lifestyle modification strategy for HCC primary prevention.
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Affiliation(s)
- Hung N Luu
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaideep Behari
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Pittsburgh Liver Research Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - George Boon-Bee Goh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Renwei Wang
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aizhen Jin
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore
| | - Claire E Thomas
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, and Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew O Odegaard
- Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine, California
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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16
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Shah NM, Malhotra AM, Kaltsakas G. Sleep disorder in patients with chronic liver disease: a narrative review. J Thorac Dis 2020; 12:S248-S260. [PMID: 33214928 PMCID: PMC7642630 DOI: 10.21037/jtd-cus-2020-012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sleep disturbance is a common feature of chronic liver disease (CLD) with impact on health-related quality of life; 60-80% of patients with CLD report subjective poor sleep; frequent presentations of sleep disturbance include insomnia, reduced sleep efficiency, increased sleep latency, reduced time in rapid eye movement (REM) sleep, restless leg syndrome and excessive daytime sleepiness (EDS). Key contributors to sleep disturbance include hepatic encephalopathy (HE) and circadian rhythm imbalance due to altered melatonin metabolism. Specific conditions causing CLD, such as non-alcoholic fatty liver disease (NAFLD), chronic viral hepatitis and primary biliary cholangitis (PBC) result in different types of sleep disturbance, and the treatment of these conditions can often also lead to sleep disturbance. There are currently limited management options for sleep disturbance in CLD. Obstructive sleep apnoea (OSA) is a common condition that causes chronic intermittent hypoxia due to airway collapse during sleep. This chronic intermittent hypoxia appears to contribute to the development of NAFLD. The presence of reactive oxygen species and the overexpression of hypoxia inducible factor 1-alpha secondary to hypoxia may be responsible for the second 'hit' of the 'two-hit' hypothesis of NAFLD. Treatment of the intermittent hypoxia with continuous positive airway pressure therapy has limited efficacy against liver dysfunction. There remain many outstanding areas of investigation in the management of sleep disturbance in CLD, and of liver dysfunction in OSA.
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Affiliation(s)
- Neeraj Mukesh Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Akanksha Mimi Malhotra
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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17
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Hu C, Zhang Y, Wang S, Lin L, Peng K, Du R, Qi H, Zhang J, Wang T, Zhao Z, Li M, Xu Y, Xu M, Li D, Bi Y, Wang W, Chen Y, Lu J. Association of bedtime with the risk of non-alcoholic fatty liver disease among middle-aged and elderly Chinese adults with pre-diabetes and diabetes. Diabetes Metab Res Rev 2020; 36:e3322. [PMID: 32268002 DOI: 10.1002/dmrr.3322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/27/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emerging evidence indicated that sleep characteristics may play important roles in the development of metabolic disorders. However, little is known as to the association between bedtime and the risk of non-alcoholic fatty liver disease (NAFLD) in individuals with pre-diabetes and diabetes. METHODS In a prospective cohort of 10 375 adults aged ≥40 years, 1960 of 3484 eligible pre-diabetic and diabetic individuals were identified for the current study. NAFLD was diagnosed using liver ultrasonography at baseline and at follow-up. Information on bedtime was obtained at baseline using a standard questionnaire. RESULTS We documented 433 incident cases of NAFLD among this study population. In multivariable-adjusted logistic regression model, later bedtime was associated with increased risk of NAFLD (29% increased risk per hour of later bedtime). Compared to individuals with bedtime ≤20:00, the odds ratios (95% confidence intervals) of NAFLD for bedtime of 20:00-22:00 and ≥22:00 were 1.56 (1.04-2.34) and 2.05 (1.31-3.20), respectively. In the subgroup analysis, significant associations were observed among those who were overweight or physically inactive, or those with metabolic syndrome or elevated 10-year risks for atherosclerotic cardiovascular disease. When estimating the joint effect of bedtime and other sleep characteristics, higher risk of incident NAFLD was observed in groups of late bed/early rise, late bed/napping (yes), late bed/bad sleeper, or late bed/shorter sleep durations. CONCLUSIONS Later bedtime was significantly associated with an increased risk of incident NAFLD in adults with pre-diabetes and diabetes, underscoring the importance of sleep behaviour management in the prevention of NAFLD.
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Affiliation(s)
- Chunyan Hu
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yi Zhang
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Shuangyuan Wang
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Lin Lin
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Kui Peng
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Rui Du
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Hongyan Qi
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Jie Zhang
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Tiange Wang
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Zhiyun Zhao
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Mian Li
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yu Xu
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Min Xu
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Donghui Li
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yufang Bi
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Weiqing Wang
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Yuhong Chen
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
| | - Jieli Lu
- Shanghai National Clinical Research Center for Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai, China
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