Variables |
Male (n =339,925) |
Female (n =340,614) |
Age |
-49.90% |
-50.10% |
20-39 |
168410(49.5%) |
171392(50.3%) |
40-59 |
135012(39.7%) |
130824(38.4%) |
? 60 |
36503(10.7%) |
38398(11.3%) |
Total |
339,925 |
340,614 |
Marital Status |
||
Single |
79647(23.47%) |
98926(29.04%) |
Married |
246674(72.56%) |
224845(66.0%) |
Missing |
134682(3.96%) |
16843(4.96%) |
Education |
||
Highschool |
41635(12.3%) |
73830(21.6%) |
College |
141120(41.5%) |
150487(44.7%) |
University |
157170(46.2%) |
116297(34.6%) |
Smoking |
||
Never |
189989(64.1%) |
310746(94.6%) |
Past |
52526(17.7%) |
9871(3.1%) |
Current |
54002(18.2%) |
7697(2.3%) |
Drinking |
||
Never |
238382(72.4%) |
301312(93.5%) |
Past |
12397(3.8%) |
3690(1.1%) |
Current |
78601(23.9%) |
17305(5.4%) |
Hypertension |
||
Yes |
30719(9.0%) |
23331(6.8%) |
No |
309206(91.0%) |
317283(93.2%) |
DM |
||
Yes |
10178(3.0%) |
7967(0.3%) |
No |
329747(97.0%) |
332647(97.7%) |
CVA |
||
Yes |
1666(0.5%) |
949(0.3%) |
No |
338259(99.5%) |
339665(99.7%) |
HeartDisease |
||
Yes |
9639(2.8%) |
9743(2.9%) |
No |
330286(97.2%) |
330871(97.1%) |
Sleep Duration |
||
0-4 hours |
2388(0.7%) |
3628(1.1%) |
4-6 hours |
67961(20.4%) |
72364(21.7%) |
6-7 hours |
32949(9.9%) |
37247(11.2%) |
7-8 hours |
228101(68.4%) |
216638(65.1%) |
> 8 hours |
2187(0.7%) |
3143(0.9%) |
Sleep Quality |
||
Poorly |
29583(8.7%) |
39364(11.6%) |
Fairly well |
143291(42.2%) |
189012(55.5%) |
Well |
167051(49.1%) |
112238(33.0%) |
Liver Function |
||
Yes |
603(0.2%) |
240(0.1%) |
No |
339319(99.8%) |
340373(99.9%) |
N=Sample Number, (%)=Sample percentage |
Figure 1 illustrates the association between sleep duration and sleep quality and liver function. According to the presence or absence of abnormal liver function, divided by the length of sleep time, most of the participants who did not suffer from abnormal liver function slept for 7-8 hours. Participants with abnormal liver function and sleep duration of 7-8 hours. Divided by sleep quality, the participants who did not suffer from abnormal liver function and had very good sleep quality. Participants with abnormal liver function and very good sleep quality.
Figure 1: Association between sleep duration and sleep quality and liver function.
Figure 2 illustrates the correlation between sleep quality and liver function and sleep duration. According to the length of sleep, participants who slept 7-8 hours versus 4-6 hours had very good sleep quality. The majority of participants without abnormal liver function and sleep duration >8 hours versus 4-6 hours and 7-8 hours.
Figure 2: Association between sleep quality and liver function and sleep duration.
Figure 3 illustrates the association between sleep duration and liver function and sleep quality. According to sleep quality, participants who slept >8 hours versus 7-8 hours had good sleep quality and very good sleep quality. Participants with no history of liver disease, very good sleep quality and good sleep quality.
Figure 3: Association between sleep duration and liver function and sleep quality
Table 2 shows that in terms of sleep quality, participants with very poor sleep quality are 1.128 times more likely to suffer from abnormal liver function than those with good sleep quality, and this difference is statistically significant; in terms of sleep time Aspects, participants who slept 0-4 hours were 1.206 times more likely to have abnormal liver function than those who slept 7-8 hours. However, these differences were not statistically significant for sleep durations of 4-6 hours, 6-7 hours, and >8 hours.
Table 2: Regression analysis of the relationship between sleep time and sleep quality and liver function.
Liver function |
|
Variables |
OR(95%CI) |
Age |
|
20-39 |
1 |
40-59 |
3.475(2.674-4.516) |
>=60 |
5.382(3.972-7.294) |
Marriage |
1.138(0.895-1.448) |
Education |
|
Highschool |
1 |
College |
0.461(0.375-0.567) |
University |
0.379(0.297-0.483) |
Smoking |
|
Never |
1 |
Past |
0.958(0.765-1.201) |
Current |
0.650(0.483-0.874) |
Drinking |
|
Never |
1 |
Past |
4.996(4.005-6.232) |
Current |
0.570(0.429-0.756) |
Hypertension |
0.993(0.796-1.238) |
DM |
1.428(1.076-1.896) |
CVA |
1.406(0.810-2.438) |
Heart Disease |
0.629(0.423-0.936) |
Sleep Quality |
|
Fairly well |
1 |
Well |
0.787(0.615-1.006) |
Poorly |
1.128(1.076-1.896) |
Sleep Duration |
|
7-8hours |
1 |
0-4hours |
1.206(1.010-1.438) |
4-6hours |
0.688(0.412-1.148) |
6-7hours |
0.664(0.262-1.686) |
>8hours |
0.494(0.305-0.800) |
*Adjusted for all variables (including age, marital status, education, smoking, drinking, hypertension, diabetes, cerebrovascular disease, and heart disease) |
DISCUSSION
Past studies have found that people with long-term sleep deprivation have abnormally elevated liver function indexes but did not point out the reason behind it. Dr. Matthew Brady of the University of Chicago convened an experiment with seven young volunteers. First, let everyone sleep 8.5 hours a day in the lab, then come back a month later for four consecutive days, sleep only 4.5 hours a day, and then test the response of their fat cells. It was found that the response of fat cells to sleep loss is very obvious. When fat cells are not sensitive to insulin, fat will run out of cells and enter the blood circulation. When the fat starts to accumulate in other parts of the body, such as in the liver, it will cause fatty liver, which will affect the body's utilization of glucose, and then cause disease. It is concluded that sleep is at least as important in energy metabolism as it is in brain function, and if humans do not get enough sleep, they will store more substances in the body, such as fat cells [8].
Stanford University scholars Kim et al. (2018) published an article in Clinical Gastroenterology and Hepatology, the top liver journal in the United States, analyzing the sleep habits of 17,245 American people, and divided them into five groups according to sleep time, respectively, less than or equal to 5 hours per day (15.9%), 6 hours (23.8%), 7 hours (27.1%), 8 hours (26.3%), and ? 9 hours (7%). It was found that people who sleep less than 5 hours a day are 35% more likely to have an abnormal liver function and 45% more likely to have fatty liver. People who took 6 hours were 24% more likely to have an abnormal liver function and 33% more likely to have fatty liver. People at 7 and 8 hours had no increased risk of abnormal liver function and fatty liver. The conclusion is that people with less sleep have a higher risk of developing abnormal liver function and fatty liver. In addition, past studies have also found that people with less sleep also have a higher proportion of fatty liver, so the author believes that the abnormal liver function caused by less sleep may be caused by chronic liver inflammation caused by the fatty liver [11].
Kim et al. (2018) pointed out that the blood flow of the liver is reduced by 40% when standing compared to lying down, and the blood flow of the liver is reduced by 80% to 85% when exercising than when lying down, and the reduction of blood flow in the liver will directly affect the Liver nutrition and oxygen supply. The liver is most active from 11:00 p.m. to 3:00 a.m., and it is also the best detoxification period for the liver. If you stay up late at this time, the blood flow of the liver will be relatively insufficient, which will increase the burden on the liver. Generally, people who stay up late often eat more dinner and supper. If they lack exercise, the excess calories will be converted into fat and stored in the liver. Over time, the fat content of the liver will exceed the standard, resulting in the occurrence of fatty liver. Clinical observations have found that most patients with fatty liver have symptoms of insomnia, fatigue, and emotional instability. Therefore, for the treatment of fatty liver, especially severe fatty liver, the importance of adequate sleep should be emphasized [12].
The association between fatty liver and short sleep duration was first reported in Japanese men. An article in the Japanese Journal of Internal Medicine, Hsieh et al. (2011) pointed out that they analyzed the sleep habits of 8,157 Japanese men and divided them into three groups according to sleep time: less than 5 hours per day (8.5%), 5 to <7 hours (75.5%), and greater than or equal to 7 hours (16%). The results found: People who sleep less than 5 hours a day have a 43% higher chance of developing fatty liver. People with 5 to <7 hours have a 38.5% chance of developing fatty liver. People with a duration of 7 hours or more have a 32.9% chance of developing fatty liver. The conclusion is that people with less sleep have a higher risk of developing abnormal liver function and fatty liver. However, the study did not control for alcohol intake, which affects fatty liver disease and sleep duration [7].
3,968 subjects were evaluated by Imaizumi et al. (2015) in Obesity Facts. Fatty liver is detected by ultrasonography. Sleep time was divided into the following categories: less than or equal to 6 hours, 6 hours to less than or equal to 7 hours, more than 7 hours to less than or equal to 8 hours, and more than 8 hours. The proportion of NAFLD tended to decrease with increasing sleep duration in men. Rates of NAFLD were lowest in the group who slept 6 to 7 hours and highest in women who slept more than 6 and more than 8 hours. The distribution is U-shaped. The age-adjusted Odds Ratio (OR) was 1.44 for female NAFLD subjects who slept 6 hours or less compared to the reference value (6 hours to 7 hours or less). It was concluded that sleep deprivation is often associated with nonalcoholic fatty liver disease in women and may be caused by physical obesity [5].
Recently, a large-scale study reported that short sleep duration and poor sleep quality were risk factors for nonalcoholic steatohepatitis in middle-aged Koreans. In the current study, it was confirmed that short sleep duration in women is often associated with nonalcoholic fatty liver disease [6].
Records from 2,429 Japanese subjects were reviewed in Miyake et al. (2015) in the Journal of Gastroenterology. The study cohort was divided into two groups: short sleep duration ( ? 6 hours) (n=1,543) and moderate sleep duration (7-8 hours) (n=886). During the observation period, a total of 296 subjects had NAFLD. Multivariate analysis identified an association between shorter sleep duration and a reduction in NAFLD episodes in men (odds: 0.551, 95% confidence interval 0.365-0.832, p=0.005). There was no association between short sleep duration and NAFLD episodes in women. The incidence of NAFLD in men increased significantly with increasing sleep time as follows: 12.5% ??(p=0.02) in subjects with 4 hours or less of sleep and 18.4% in subjects with 5-6 hours of sleep, respectively % (p=0.02) and 27.4% (p=0.02) in subjects aged 7-8 hours. Miyake et al. (2015) indicated that sleep loss was associated with a lower risk of nonalcoholic fatty liver disease in men [13]. However, there was no significant association between short sleep duration and fatty liver disease risk in men and observed similar results in men and women, prolonged sleep may prevent fatty liver disease, but this result was not supported by subsequent studies [5,7].
This study has several limitations. First, this study was a cross-sectional survey, which could not identify a causal or temporal relationship between metabolic markers and liver function; and it was difficult to conduct a detailed analysis of sleep quality. Secondly, abnormal liver function diseases involve too many levels, such as fatty liver, abnormal GPT, B liver disease, etc. A complete analysis report is required for each disease. Third, self-reported sleep parameters are not without limitations, overreporting of sleep duration by self-reporting has been described, and self-reporting is only moderately correlated with an objective assessment of sleep duration. Fourth, the findings found in this study should be considered a limitation of this study based on measures of association effects (indirect effects) rather than causal effect relationships. Finally, future studies should discuss the work in a more in-depth and extensive way [14-22].
It is suggested that in daily life, in addition to exercising, going to bed before 11 O'clock every night, avoiding staying up late, and not taking home remedies, herbs, and healthy foods with unknown ingredients are all important factors for maintaining liver health. In terms of diet, it is recommended that people with poor liver health should eat three meals regularly, avoid excessive drinking, quit smoking, and consume foods rich in B group such as dark green vegetables and whole grains; and people with fatty liver should reduce the number of meals Tips for eating desserts, snacks, cutting down on fat intake, having dinner before 8, and avoiding late-night snacks.
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