Michael Hunter, MD on Medika Life

One More Peril of Short Sleep

People with sedentary lifestyles and poor sleep behaviors appear more likely to develop fatty liver disease.

“Sleep, those little slices of death — how I loathe them.”
― Edgar Allan Poe

A HEALTHY LIFESTYLE IS ASSOCIATED WITH A LOWER RISK of developing fatty liver disease. Today we explore the connection between inadequate sleep and fatty liver disease.

First, did you catch the error in my post illustration? The striking image at the top of this piece has a bull’s eye on the stomach, not the liver. Don’t worry: I did not skip the Yale School of Medicine anatomy class.

Let’s get back to one of the dangers of insufficient sleep. Fatty liver disease is the leading chronic liver disease worldwide, striking one in four of the population.

Abdominal anatomy. https://en.wikipedia.org/wiki/Liver

Fatty liver disease

Fatty liver disease is a common condition resulting from too much-stored fat in the liver. Most individuals have no symptoms, but the fatty liver disease can occasionally lead to liver damage.

That’s the bad news. The good news is that you can often prevent (or even reverse) fatty liver disease with positive lifestyle interventions.

Fatty liver disease is common.

Non-alcoholic fatty liver disease (NAFLD) happens in those who aren’t heavy consumers of alcohol. The condition affects about one in three adults (and one in ten childer) in the United States. Worldwide, the disease affects one in four adults, according to the Cleveland Clinic (USA).

Scientists do not know the exact cause of non-alcoholic fatty liver disease. However, we know several factors, including diabetes and obesity, can increase your risk. Moreover, fatty liver disease may progress to end-stage liver disease.

Fatty liver disease hits certain groups more.

Non-alcoholic fatty liver disease can affect anyone, regardless of age or race. By race, it appears more common among individuals of Hispanic descent, and Black people are less likely to get NAFLD (with whites in the middle).

Of those with non-alcoholic fatty disease, up to 75 percent have obesity or diabetes. Looking the other direction, up to 90 percent of those with advanced or class III obesity have non-alcoholic fatty liver disease.

Fatty liver disease causes

Before we get to the sleep and fatty liver relationship, let’s look at some suspected factors:

  • Diet. A high fructose diet may increase your risk of developing non-alcoholic fatty liver disease. Think common table sugar and high fructose corn syrup. Alas, the latter is a common added sweetener in many American foods. I have become a label reader. I want to avoid metabolic syndrome, a disease cluster that increases our risk of heart disease, stroke, and type 2 diabetes. The risk-raising conditions include high blood sugar, too much body fat around the waist, abnormal cholesterol or triglyceride levels, and high blood pressure.
  • Genetics. Inherited genetics may explain why individuals of certain races appear to get fatty liver disease more often.
Photo by Slashio Photography on Unsplash

Fatty liver disease causes

Researchers suspect several factors contribute to non-alcoholic fatty liver risk, including:

  • Metabolic syndrome. Non-alcoholic fatty liver disease seems linked to a group of related metabolic disorders involving high body mass index, elevated blood lipid levels, diabetes, and high blood pressure. These factors influence one another and affect how your body stores fats and metabolizes nutrients.
  • Diet and nutritional causes. A fructose-rich diet can increase your risk of developing NAFLD. Fructose is one of the ingredients in common table sugar and is the dominant ingredient in high fructose corn syrup, a common sweetener. It’s highly linked to metabolic syndrome.
  • Genetics. Inherited genes may make you more likely to develop NAFLD. It may also help explain why individuals of certain races seem to get it more often.
  • Gallbladder removal (cholecystectomy).

You may wonder if you should have screening for non-alcoholic fatty liver disease, particularly if you have a risk factor such as obesity or diabetes.

The American Association for the Study of Liver Diseases guidelines does not call for screening given uncertainties around which test to use (since liver enzyme levels may be normal in patients with NAFLD), how to treat NAFLD if discovered, and whether screening is cost-effective.

Fatty liver disease — possible complications

Here are the two major complications of non-alcoholic fatty liver disease:

  • Pregnancy complications. NAFLD in pregnancy is associated with a higher risk of complications for the mother and fetus. For example, high blood pressure problems (such as preeclampsia) are more likely to affect the mother. Other associated problems include bleeding after delivery and preterm birth. Non-alcoholic fatty liver disease in pregnancy has tripled over the past ten years in the United States.
  • Steatohepatitis. Up to 20 percent of individuals with non-alcoholic fatty liver disease may develop non-alcoholic steatohepatitis (NASH) or chronic liver inflammation. This inflammatory state can progressively damage the liver, culminating in scarring (cirrhosis).
Photo by Kate Stone Matheson on Unsplash

Non-alcoholic fatty disease risk and short sleep

Do you have a sedentary lifestyle? Are you getting insufficient sleep? A new study points to a higher risk of developing fatty liver disease.

According to Dr. Yan Liu of Guangdong (China), the takeaway message is:

“Those with poor nighttime sleep and prolonged daytime napping have the highest risk for developing fatty liver disease. A moderate improvement in sleep quality appeared associated with a nearly one-third (29 percent) drop in fatty liver disease risk (even for those with unhealthy lifestyles).

The scientists arrived at their conclusions by analyzing self-reported sleep behaviors from just over 5,000 Chinese adults. Late bedtime, daytime napping for more than 30 minutes, and snoring appeared to be linked to an increased risk of fatty liver disease.

Sedentary individuals and those with central obesity had especially noticeable adverse effects from poor sleep quality.

Summary: Sleep and fatty liver disease

In summary, even a moderate improvement in sleep quality can reduce the risk for fatty liver disease, especially in those with unhealthy lifestyles. Thank you for joining me today.


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Michael Hunter, MD
Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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