Joint association of sleep quality and physical activity with metabolic dysfunction-associated fatty liver disease: a population-based cross-sectional study in Western China

BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a growing global health burden. Poor sleep and physical inactivity are common and independently associated with MAFLD, but their joint effects remain unclear. METHODS: In a population-based cross-sectional study conducted in Xinjiang, China (July 2019–September 2021), self-reported sleep behaviors and physical activity (PA) were collected via validated questionnaires, and MAFLD was diagnosed radiologically. RESULTS: Among 10,089 participants (mean age 47.0 years; 51.6% men), 38.2% had MAFLD. Poor sleep quality and physical inactivity were independently and jointly associated with higher MAFLD prevalence after adjustment for traditional risk factors (P < 0.05). Compared with participants meeting guideline-recommended moderate-to-vigorous PA (MVPA) and having good sleep quality, those with no recommended MVPA and poor sleep had the highest odds of MAFLD (OR = 2.36, 95% CI: 1.81–3.08). Improving sleep quality substantially attenuated MAFLD prevalence regardless of PA volume, whereas PA well above current guidelines did not adequately counteract the adverse impact of poor sleep. CONCLUSIONS: Public health strategies should simultaneously target sleep quality and PA to curb the rising prevalence of MAFLD.

Ying Wang, Qian Zhao, Jialu Yang, Yushan Wang, Lei Deng, Hamulati Xieyire, Tuerxun Gulijiehere, Mutalifu Munire, Fen Liu, Xiaomei Li, Min Xia, Yan Liu, Yining Yang