睡眠时长与非酒精性脂肪性肝病的关联

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doi:10.16462/j.cnki.zhjbkz.2023.01.009

欧夏娴¹,
李闵涛¹,
吕筠^{1, 4, 5},
孙点剑一^{1, 4},
马圆²,
满塞丽麦^{1, 4},
尹建春³,
王波^4,,,
余灿清^{1, 4, 5,,},
李立明^{1, 4, 5}

1.
100191 北京，北京大学公共卫生学院流行病与卫生统计学系
2.
100191 北京，中关村美年健康产业研究院
3.
100006 北京，北京美兆健康体检中心
4.
100191 北京，北京大学医学部美年公众健康研究院
5.
100191 北京，北京大学公众健康与重大疫情防控战略研究中心

基金项目:

国家自然科学基金91846303

国家自然科学基金81941018

详细信息

通讯作者:
王波，E-mail：paul@meinianresearch.com
余灿清，E-mail：yucanqing@pku.edu.cn

中图分类号:R575.5
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出版历程
- 收稿日期:2022-01-28
- 修回日期:2022-06-13
- 网络出版日期:2023-02-09
- 刊出日期:2023-01-10

The association of sleep duration with non-alcoholic fatty liver disease

OU Xia-xian¹,
LI Min-tao¹,
LYU Jun^{1, 4, 5},
SUN Dian-jian-yi^{1, 4},
MA yuan²,
MAN Sai-li-mai^{1, 4},
YIN Jian-chun³,
WANG Bo^4,,,
YU Can-qing^{1, 4, 5,,},
LI Li-ming^{1, 4, 5}

1.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
2.
Meinian Institute of Health, Beijing 100191, China
3.
MJ Health Screening Center, Beijing 100006, China
4.
Meinian Institute of Health, Peking University Health Science Center, Beijing 100191, China
5.
Center for Public Health and Major Epidemic Prevention and Control, Peking University, Beijing 100191, China

Funds:

National Natural Science Foundation of China91846303

National Natural Science Foundation of China81941018

More Information

Corresponding author:WANG Bo, E-mail:paul@meinianresearch.com;YU Can-qing, E-mail:yucanqing@pku.edu.cn

摘要

摘要: 目的基于2008－2018年北京市城区年龄≥18岁人群的体检资料，探究睡眠时长与非酒精性脂肪性肝病(non-alcoholic fatty liver disease，NAFLD)之间的关联。方法利用北京美兆体检中心2008－2018年体检资料，采取横断面调查研究，采用多变量logistic回归分析模型探究睡眠时长与NAFLD患病之间的关联，并进一步分析不同亚人群中睡眠时长与NAFLD的关联。结果共纳入77 697名体检对象，年龄为(40.7±11.7)岁，短睡眠时长(< 6 h)与长睡眠时长(≥8 h)分别占12.7%与7.0%，NAFLD的超声检出率为37.6%。调整潜在混杂因素后，短睡眠时长和长睡眠时长与正常睡眠时长的体检对象相比患有NAFLD的 OR值分别为1.08(95% CI: 1.03~1.14， P=0.003)和0.88(95% CI: 0.82~0.95， P< 0.001)，且短睡眠时长与NAFLD的关联在男性( P _交互< 0.05)及18~ < 30岁、30~ < 40岁的人群中( P _交互< 0.001)更为显著；进一步调整BMI后，发现睡眠时长与NAFLD的关联无统计学意义( P> 0.05)。结论睡眠时长与NAFLD风险有关，尤其在男性和年轻人中；BMI在睡眠时长与NAFLD的关系中起重要作用。
- 睡眠时长/
- 非酒精性脂肪性肝病/
- 横断面研究/
- BMI
Abstract: ObjectiveTo explore the association of sleep duration with non-alcoholic fatty liver disease (NAFLD) among a health checkup population aged 18 years or older in urban District of Beijing from 2008 to 2018. MethodsA cross-sectional study was designed based on the health checkup data from 2008 to 2018 at Beijing MJ Health Screening Center. Multinomial logistic regression was used to explore the association of sleep duration with NAFLD, and further to assess the associations across different subgroups according to related covariates. ResultsAmong 77 697 participants, the average age was (40.7±11.7) years. Of 12.7% reported a sleep duration of fewer than six hours, and 7.0% reported eight hours and more, respectively. The detection rate of NAFLD by ultrasound scan was 37.6%. After adjusting for the potential confounders, the odds ratio (95% CI) for NAFLD for short sleep duration and long sleep duration compared to the reference(normal sleep duration) were 1.08 (95% CI: 1.03-1.14, P=0.003) and 0.88 (95% CI: 0.82-0.95, P< 0.001), respectively. The association of short sleep duration with NAFLD was more substantial in males ( P _interaction< 0.05) and individuals aged 18 to 29 and 30 to 39 years old ( P _interaction< 0.001). However, the association was no longer significant ( P> 0.05) when further adjusting BMI. ConclusionsSleep duration is associated with the risk of NAFLD, especially in males and young adults. Meanwhile, BMI played a vital role in the association between sleep duration and NAFLD.
- Sleep duration/
- Non-alcoholic fatty liver disease/
- Cross-sectional studies/
- BMI

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表 1不同睡眠时长的体检对象基本特征[n(%)]

Table 1.Basic characteristics of participants with different sleep duration [n(%)]

变量	短睡眠时长	正常睡眠时长	长睡眠时长
男性	5 321(54.0)	34 533(55.4)	2 490(45.7)
年龄(岁)
18~ < 30	1 051(10.7)	12 316(19.7)	1 295(23.8)
30~ < 40	2 181(22.1)	20 504(33.0)	1 887(34.6)
40~ < 50	2 729(27.7)	17 119(27.4)	1 256(23.0)
≥50	3 899(39.5)	12 347(19.8)	1 013(18.6)
教育水平
高中及以下	1 920(19.5)	6 036(9.7)	806(14.8)
大中专或本科	6 147(62.3)	37 752(60.5)	3 246(59.5)
硕士及以上	1 793(18.2)	18 598(29.8)	1 399(25.7)
吸烟	2 708(27.5)	14 883(23.9)	1 221(22.4)
饮酒	2 739(27.8)	14 830(23.8)	1 105(20.3)
运动量
低	3 655(37.1)	23 796(38.1)	2 313(42.4)
中	2 456(24.9)	17 370(27.8)	1 419(26.0)
高	3 749(38.0)	21 220(34.0)	1 719(31.5)
BMI(kg/m²)
正常	4 337(44.0)	32 838(52.6)	3 235(59.4)
超重	3 801(38.5)	21 468(34.4)	1 638(30.0)
肥胖	1 722(17.5)	8 080(13.0)	578(10.6)
失眠症状	7 103(72.0)	33 442(53.6)	2 593(47.6)
高血压	2 274(23.1)	9 254(14.8)	712(13.1)
糖尿病	1 086(11.0)	3 781(6.1)	328(6.0)
血脂异常	3 133(31.8)	16 711(26.8)	1 360(24.9)
高血肌酐	163(1.7)	965(1.5)	84(1.5)
高尿酸	1 969(20.0)	11 312(18.1)	859(15.8)
注：除高血肌酐这一项的P值为0.452外，其余P值均 < 0.001。

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表 2睡眠时长与NAFLD的多因素logistic回归分析模型

Table 2.Multivariate logistic regression analysis of sleep duration and risk of NAFLD

变量	OR(95%CI)值				P_趋势
变量	短睡眠时长	正常睡眠时长	长睡眠时长	每增加1 h	P_趋势
人数(n)	9 860	62 386	5 451
NAFLD检出率(%)	44.4	37.0	32.0
模型1	1.11(1.06~1.17)	1.00	0.92(0.86~0.98)	0.93(0.92~0.95)	< 0.001
模型2	1.10(1.05~1.16)	1.00	0.91(0.85~0.97)	0.94(0.92~0.95)	< 0.001
模型3	1.08(1.03~1.14)	1.00	0.88(0.82~0.95)	0.93(0.92~0.95)	< 0.001
模型3+BMI	0.97(0.91~1.02)	1.00	0.97(0.90~1.05)	0.99(0.97~1.01)	0.443
注：模型1调整了性别、年龄、教育水平；模型2进一步调整了吸烟、饮酒、运动量；模型3增加了失眠症状、高血压、糖尿病、血脂异常、血肌酐、血尿酸变量。

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表 3睡眠时长与其他变量对NAFLD的交互作用分析

Table 3.Analysis of the interaction between sleep duration and other variables on the risk of NAFLD

变量	人数(n)	短睡眠时长	长睡眠时长	P_交互值
变量	人数(n)	OR(95%CI)值	OR(95%CI)值	P_交互值
性别				0.049
男	42 344	1.11 (1.04~1.19)	0.90 (0.83~0.99)
女	35 353	0.97 (0.90~1.06)	0.92 (0.82~1.03)
年龄(岁)				< 0.001
18~ < 30	14 662	1.37 (1.14~1.64)	0.92 (0.75~1.12)
30~ < 40	24 672	1.22 (1.09~1.36)	0.89 (0.78~1.00)
40~ < 50	21 104	1.09 (0.99~1.19)	0.88 (0.77~1.01)
≥50	17 259	0.90 (0.84~0.98)	0.99 (0.86~1.13)
吸烟				0.074
不吸烟	58 885	1.08 (1.01~1.14)	0.89 (0.82~0.97)
吸烟	18 812	1.05 (0.96~1.16)	0.89 (0.78~1.01)
饮酒				0.107
不饮酒	59 023	1.08 (1.02~1.15)	0.88 (0.81~0.96)
饮酒	18 674	1.06 (0.97~1.17)	0.89 (0.78~1.03)
运动量				0.280
低	29 764	1.08 (0.99~1.18)	0.82 (0.73~0.92)
中	21 245	1.09 (0.98~1.20)	0.98 (0.86~1.13)
高	26 688	1.06 (0.98~1.15)	0.88 (0.78~0.99)
失眠症状				0.534
无	34 559	1.13 (1.03~1.24)	0.91 (0.83~1.00)
有	43 138	1.04 (0.98~1.11)	0.86 (0.77~0.95)
注：在多变量模型(模型3)的基础上进行分析，模型调整了性别、年龄、教育水平、吸烟、饮酒、运动量、失眠症状、高血压、糖尿病、血脂异常、血肌酐、血尿酸变量。

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参考文献 (25)

[1]	Rinella ME. Nonalcoholic fatty liver disease: a systematic review[J]. JAMA, 2015, 313(22): 2263-2273. DOI:10.1001/jama.2015.5370.
[2]	Bellentani S, Saccoccio G, Masutti F, et al. Prevalence of and risk factors for hepatic steatosis in northern Italy[J]. Ann Intern Med, 2000, 132(2): 112-117. DOI:10.7326/0003-4819-132-2-200001180-00004.
[3]	Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64(1): 73-84. DOI:10.1002/hep.28431.
[4]	Sun X, Zheng B, Lyu J, et al. Sleep behavior and depression: findings from the China kadoorie biobank of 0.5 million Chinese adults[J]. J Affect Disord, 2018, 229: 120-124. DOI:10.1016/j.jad.2017.12.058.
[5]	Beijamin F, Knutson KL, Lorenzi-Filho G, et al. Timing and quality of sleep in a rural brazilian family-based cohort, the baependi heart study[J]. Sci Rep, 2016, 6: 39283. DOI:10.1038/srep39283.
[6]	Okamura T, Hashimoto Y, Hamaguchi M, et al. Short sleep duration is a risk of incident nonalcoholic fatty liver disease: a population-based longitudinal study[J]. J Gastrointestin Liver Dis, 2019, 28(1): 73-81. DOI:10.15403/jgld.2014.1121.281.alc.
[7]	Jasani FS, Seixas AA, Madondo K, et al. Sleep duration and health care expenditures in the United States[J]. Med Care, 2020, 58(9): 770-777. DOI:10.1097/MLR.0000000000001351.
[8]	Miyake T, Kumagi T, Furukawa S, et al. Short sleep duration reduces the risk of nonalcoholic fatty liver disease onset in men: a community-based longitudinal cohort study[J]. J Gastroenterol, 2015, 50(5): 583-589. DOI:10.1007/s00535-014-0989-0.
[9]	Chou YT, Cheng HJ, Wu JS, et al. The association of sleep duration and sleep quality with non-alcoholic fatty liver disease in a Taiwanese population[J]. Obes Res Clin Pract, 2018, 12(6): 500-505. DOI:10.1016/j.orcp.2018.05.002.
[10]	Liu C, Zhong R, Lou J, et al. Nighttime sleep duration and risk of nonalcoholic fatty liver disease: the Dongfeng-Tongji prospective study[J]. Ann Med, 2016, 48(6): 468-476. DOI:10.1080/07853890.2016.1193787.
[11]	Peng K, Lin L, Wang Z, et al. Short sleep duration and longer daytime napping are associated with non-alcoholic fatty liver disease in Chinese adults[J]. J Diabetes, 2017, 9(9): 827-836. DOI:10.1111/1753-0407.12489.
[12]	王月清, 孙点剑一, 潘烺, 等. 2008-2018年北京城区某体检人群不健康饮食长期变化趋势[J]. 中华疾病控制杂志, 2021, 25(3): 289-294. DOI:10.16462/j.cnki.zhjbkz.2021.03.008. Wang YQ, Sun DJY, Pan L, et al. Long-term trend in unhealthy diet intake among a health examination population in urban Beijing, 2008-2018[J]. Chin J Dis Control Prev, 2021, 25(3): 289-294. DOI:10.16462/j.cnki.zhjbkz.2021.03.008.
[13]	Hirshkowitz M, Whiton K, Albert SM, et al. National sleep foundation's updated sleep duration recommendations: final report[J]. Sleep Health, 2015, 1(4): 233-243. DOI:10.1016/j.sleh.2015.10.004.
[14]	Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the american association for the study of liver diseases[J]. Hepatology, 2018, 67(1): 328-357. DOI:10.1002/hep.29367.
[15]	Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities[J]. Med Sci Sports Exerc, 2000, 32(9): 498-504. DOI:10.1097/00005768-200009001-00009.
[16]	Matthews CE, Moore SC, Arem H, et al. Amount and intensity of leisure-time physical activity and lower cancer risk[J]. J Clin Oncol, 2020, 38(7): 686-697. DOI:10.1200/JCO.19.02407.
[17]	Graham JW. Missing data analysis: making it work in the real world[J]. Annu Rev Psychol, 2009, 60: 549-576. DOI:10.1146/annurev.psych.58.110405.085530.
[18]	中华人民共和国卫生部疾病预防控制司. 中国成人超重和肥胖症预防控制指南[M]. 北京: 人民卫生出版社, 2006: 2-4. Department of Disease Prevention and Control, Ministry of Health, PRC. Guidelines for prevention and control of overweight and obesity in Chinese adults[M]. Beijing: People's Medical Publishing House, 2006: 2-4.
[19]	Wijarnpreecha K, Thongprayoon C, Panjawatanan P, et al. Short sleep duration and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis[J]. J Gastroenterol Hepatol, 2016, 31(11): 1802-1807. DOI:10.1111/jgh.13391.
[20]	Kim CW, Yun KE, Jung HS, et al. Sleep duration and quality in relation to non-alcoholic fatty liver disease in middle-aged workers and their spouses[J]. J Hepatol, 2013, 59(2): 351-357. DOI:10.1016/j.jhep.2013.03.035.
[21]	Spiegel K, Tasali E, Penev P, et al. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite[J]. Ann Intern Med, 2004, 141(11): 846-850. DOI:10.7326/0003-4819-141-11-200412070-00008.
[22]	Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation[J]. Biol Psychiatry, 2016, 80(1): 40-52. DOI:10.1016/j.biopsych.2015.05.014.
[23]	Vgontzas AN, Bixler EO, Lin HM, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications[J]. J Clin Endocrinol Metab, 2001, 86(8): 3787-3794. DOI:10.1210/jcem.86.8.7778.
[24]	Kamada Y, Kiso S, Yoshida Y, et al. Estrogen deficiency worsens steatohepatitis in mice fed high-fat and high-cholesterol diet[J]. Am J Physiol Gastrointest Liver Physiol, 2011, 301(6): G1031-G1043. DOI:10.1152/ajpgi.00211.2011.
[25]	Zhu L, Brown WC, Cai Q, et al. Estrogen treatment after ovariectomy protects against fatty liver and may improve pathway-selective insulin resistance[J]. Diabetes, 2013, 62(2): 424-434. DOI:10.2337/db11-1718.

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变量	短睡眠时长	正常睡眠时长	长睡眠时长
男性	5 321(54.0)	34 533(55.4)	2 490(45.7)
年龄(岁)
18~ < 30	1 051(10.7)	12 316(19.7)	1 295(23.8)
30~ < 40	2 181(22.1)	20 504(33.0)	1 887(34.6)
40~ < 50	2 729(27.7)	17 119(27.4)	1 256(23.0)
≥50	3 899(39.5)	12 347(19.8)	1 013(18.6)
教育水平
高中及以下	1 920(19.5)	6 036(9.7)	806(14.8)
大中专或本科	6 147(62.3)	37 752(60.5)	3 246(59.5)
硕士及以上	1 793(18.2)	18 598(29.8)	1 399(25.7)
吸烟	2 708(27.5)	14 883(23.9)	1 221(22.4)
饮酒	2 739(27.8)	14 830(23.8)	1 105(20.3)
运动量
低	3 655(37.1)	23 796(38.1)	2 313(42.4)
中	2 456(24.9)	17 370(27.8)	1 419(26.0)
高	3 749(38.0)	21 220(34.0)	1 719(31.5)
BMI(kg/m²)
正常	4 337(44.0)	32 838(52.6)	3 235(59.4)
超重	3 801(38.5)	21 468(34.4)	1 638(30.0)
肥胖	1 722(17.5)	8 080(13.0)	578(10.6)
失眠症状	7 103(72.0)	33 442(53.6)	2 593(47.6)
高血压	2 274(23.1)	9 254(14.8)	712(13.1)
糖尿病	1 086(11.0)	3 781(6.1)	328(6.0)
血脂异常	3 133(31.8)	16 711(26.8)	1 360(24.9)
高血肌酐	163(1.7)	965(1.5)	84(1.5)
高尿酸	1 969(20.0)	11 312(18.1)	859(15.8)
注：除高血肌酐这一项的P值为0.452外，其余P值均 < 0.001。

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