Nonalcoholic fatty liver disease, sleep behaviors, and incident type 2 diabetes

Objectives: Nonalcoholic 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.

Methods: This prospective cohort study included 362,834 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. Liver steatosis was based on the fatty liver index.

Results: During a median follow-up of 10.9 years, we documented 7,394 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 independent...