This study investigated the association between traditional healthy lifestyles (HLS), sleep quality, and metabolic dysfunction-associated fatty liver disease (MAFLD). Two population-based studies, the Imaging Subcohort of South China Cohort (ISSCC) and the US National Health and Nutrition Examination Survey (US NHANES), were used. A new metric, Liver Essential 5, was created by incorporating sleep quality into traditional HLS. Results showed that sleep quality mediated 4.66–17.72% of the association between traditional HLS and MAFLD. Individuals with poor sleep and unfavorable HLS had significantly higher odds of MAFLD. Liver Essential 5 improved risk stratification for MAFLD and related outcomes. Each one-point increase in Liver Essential 5 was associated with a reduced risk for MAFLD.

Jialu Yang, Qi Zhang, Wanying Zhao, Bingqi Ye, Siqi Li, Zhuoyu Zhang, Jingmeng Ju, Jialin He, Min Xia, Tiantian Xiong, Yan Liu