Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
J Gastroenterol Hepatol. 2022 Aug;37(8):1633-1640. doi: 10.1111/jgh.15877. Epub 2022 May 10.
Non-alcoholic fatty liver disease (NAFLD) is associated with incident type 2 diabetes; however, the extent to which NAFLD may confer its risk remains uncertain, especially in Europeans. Emerging evidence suggests that sleep behaviors are linked to NAFLD and diabetes. We aimed to measure whether sleep behaviors modified the association between NAFLD and incident type 2 diabetes.
This prospective cohort study included 365 339 participants without type 2 diabetes at baseline in UK Biobank data. Five sleep behaviors, including sleep duration, insomnia, snoring, chronotype, and daytime sleepiness, were collected from the questionnaire. Overall sleep patterns were created by summing the five scores. Liver steatosis was based on the fatty liver index.
During a median follow up of 11.0 years, we documented 8774 patients with incident type 2 diabetes. NAFLD was significantly associated with increased diabetes risk. Sleeping 7-8 h/day, no insomnia, no self-reported snoring, and no frequent daytime sleepiness were independently associated with incident type 2 diabetes, with a 20%, 18%, 16%, and 31% lower risk, respectively. About 33.8% and 33.5% of type 2 diabetes events in this cohort could be attributed to NAFLD and poor sleep pattern, respectively. Participants with NAFLD and poor sleep pattern showed the highest risk of type 2 diabetes (relative risk 3.17, 95% confidence interval 2.80, 3.59). Sleep pattern (healthy, intermediate, and poor) did not significantly modify the association between NAFLD and type 2 diabetes. However, when studying separately, we found a significant interaction between NAFLD and insomnia on the risk of incident type 2 diabetes (P for interaction = 0.003).
In this large prospective study, both NAFLD and some sleep behaviors were risk factors for type 2 diabetes. Although overall sleep pattern did not modify the association between NAFLD and type 2 diabetes, certain sleep behavior, especially insomnia, showed the modification effect.
非酒精性脂肪性肝病（NAFLD）与 2 型糖尿病的发生有关；然而，NAFLD 可能导致其风险的程度仍不确定，尤其是在欧洲人群中。新出现的证据表明，睡眠行为与 NAFLD 和糖尿病有关。我们旨在衡量睡眠行为是否改变了 NAFLD 与 2 型糖尿病发病的关联。
本前瞻性队列研究纳入了 UK Biobank 数据中基线时无 2 型糖尿病的 365339 名参与者。通过问卷收集了 5 种睡眠行为，包括睡眠时间、失眠、打鼾、昼夜节律和白天嗜睡。通过将这 5 项评分相加来创建整体睡眠模式。肝脂肪变性基于脂肪肝指数。
在中位随访 11.0 年期间，我们记录了 8774 例新发 2 型糖尿病患者。NAFLD 与糖尿病风险增加显著相关。每天睡 7-8 小时、无失眠、无自述打鼾和无频繁白天嗜睡与新发 2 型糖尿病的风险分别降低 20%、18%、16%和 31%相关。该队列中约 33.8%和 33.5%的 2 型糖尿病事件可归因于 NAFLD 和不良睡眠模式。NAFLD 和不良睡眠模式的患者发生 2 型糖尿病的风险最高（相对风险 3.17，95%置信区间 2.80，3.59）。睡眠模式（健康、中等和不良）并未显著改变 NAFLD 与 2 型糖尿病之间的关联。然而，当分别研究时，我们发现 NAFLD 和失眠之间存在显著的交互作用，影响 2 型糖尿病的发病风险（交互作用 P 值=0.003）。
在这项大型前瞻性研究中，NAFLD 和某些睡眠行为都是 2 型糖尿病的危险因素。尽管总体睡眠模式并未改变 NAFLD 与 2 型糖尿病之间的关联，但某些睡眠行为，尤其是失眠，显示出了修饰作用。
