Mediating roles of insulin resistance and inflammatory markers between healthy sleep scores and metabolic dysfunction-associated steatotic liver disease

doi:10.3748/wjg.v32.i21.118057

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jun 7, 2026; 32(21): 118057
Published online Jun 7, 2026. doi: 10.3748/wjg.v32.i21.118057

Table 1 General characteristics of participants in the study

	Overall, n = 7871	Non-MASLD, n = 6155 (78.20%)	MASLD, n = 1716 (21.80%)
Age (year)	47.27 ± 12.44	46.67 ± 12.39	49.42 ± 12.37
Sex
Male	2920 (37.10)	2150 (34.93)	770 (44.87)
Female	4951 (62.90)	4005 (65.07)	946 (55.13)
Education
Less than high school	3149 (40.01)	2388 (38.80)	761 (44.35)
Completed high school	1872 (23.78)	1477 (24.00)	395 (23.02)
Beyond high school	2850 (36.21)	2290 (37.21)	560 (32.63)
Smoking
Never	6809 (86.51)	5356 (87.02)	1453 (84.67)
Previous	248 (3.15)	198 (3.22)	50 (2.91)
Current	814 (10.34)	601 (9.76)	213 (12.41)
Physical exercise
No exercise	3563 (45.27)	2756 (44.78)	807 (47.03)
Low intensity exercise	2352 (29.88)	1846 (29.99)	506 (29.49)
Moderate intensity exercise	1027 (13.05)	815 (13.24)	212 (12.35)
High intensity exercise	929 (11.80)	738 (11.99)	191 (11.13)
BMI (kg/m²)	23.66 ± 3.37	22.87 ± 2.94	26.51 ± 3.31
Abused drink
No	7701 (97.84)	5985 (97.24)	1716 (100.00)
Yes	170 (2.16)	170 (2.76)	0 (0.00)
CAP (dB/m)	239.10 ± 50.42	218.45 ± 32.17	313.17 ± 30.56
LSM (kPa)	5.55 ± 1.81	5.36 ± 1.66	6.25 ± 2.13
WC (cm)	80.24 ± 9.94	77.96 ± 8.94	88.41 ± 9.02
TG (mmol/L)	1.41 ± 1.38	1.22 ± 1.05	2.08 ± 2.06
TC (mmol/L)	5.32 ± 0.20	5.31 ± 0.20	5.36 ± 0.19
HDL-C (mmol/L)	1.45 ± 0.33	1.49 ± 0.33	1.28 ± 0.30
LDL-C (mmol/L)	3.00 ± 0.73	2.94 ± 0.72	3.19 ± 0.75
RC (mmol/L)	0.93 ± 0.50	0.87 ± 0.44	1.12 ± 0.63
Non-HDL-C (mmol/L)	3.92 ± 1.03	3.82 ± 0.99	4.31 ± 1.06
HOMA-IR	3.27 ± 5.44	2.28 ± 4.53	5.03 ± 7.63
hs-CRP (mg/L)	1.95 ± 4.74	1.65 ± 4.82	3.01 ± 4.28
Hypertension
No	5912 (75.92)	4797 (78.92)	1115 (65.24)
Yes	1875 (24.08)	1281 (21.08)	594 (34.76)
Diabetes
No	6493 (82.49)	5336 (86.69)	1157 (67.42)
Yes	1378 (17.51)	819 (13.31)	559 (32.58)
Fibrosis
No	7387 (93.85)	5903 (95.91)	1484 (86.48)
Yes	484 (6.15)	252 (4.09)	232 (13.52)
Sleep 7-8 hours/day	4766 (60.55)	3739 (60.75)	1027 (59.85)
Early chronotype	5508 (69.98)	4348 (70.64)	1160 (67.60)
Never/rarely insomnia	5981 (75.99)	4679 (76.02)	1302 (75.87)
No apnea symptoms	7695 (97.76)	6039 (98.12)	1656 (96.50)
No excessive daytime sleepiness	2549 (32.38)	1996 (32.43)	553 (32.23)
HSS
0-2	1625 (20.65)	1254 (20.37)	371 (21.62)
3	2512 (31.91)	1941 (31.54)	571 (33.28)
4	2631 (33.43)	2089 (33.94)	542 (31.59)
5	1103 (14.01)	871 (14.15)	232 (13.52)

Continuous variables are described as mean ± SD, and categorical variables are presented as n (%). MASLD: Metabolic dysfunction-associated steatotic liver disease; BMI: Body mass index; CAP: Controlled attenuation parameter; LSM: Liver stiffness measurement; WC: Waist circumference; TG: Triglycerides; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; Non-HDL-C: Non-high-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; RC: Remnant cholesterol; HOMA-IR: Homeostasis model assessment of insulin resistance; hs-CRP: High-sensitivity C-reactive protein; HSS: Healthy sleep score.

Full Size Table

Table 2 Association between the individual components and total score of healthy sleep score with metabolic dysfunction-associated steatotic liver disease

	n (%)	Model 1¹		Model 2²		Model 3³
	n (%)	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
Sleep patterns	7871 (100)
Sleep 7-8 hours/day	4766 (60.55)	0.94 (0.84-1.05)	0.291	0.95 (0.85-1.07)	0.394	0.91 (0.80-1.04)	0.156
Early chronotype	5508 (69.98)	0.73 (0.65-0.83)	< 0.001	0.73 (0.64-0.83)	< 0.001	0.72 (0.62-0.83)	< 0.001
Never/rarely insomnia	5981 (75.99)	0.98 (0.86-1.11)	0.755	0.98 (0.86-1.11)	0.754	0.84 (0.72-0.97)	0.017
No apnea symptoms	7695 (97.76)	0.57 (0.41-0.78)	< 0.001	0.57 (0.42-0.79)	< 0.001	0.68 (0.47-0.98)	0.040
No excessive daytime sleepiness	2549 (32.38)	0.89 (0.79-1.00)	0.050	0.89 (0.79-1.00)	0.050	0.83 (0.72-0.95)	0.005
Healthy sleep score	7871 (100)	0.90 (0.85-0.95)	0.001	0.90 (0.85-0.95)	< 0.001	0.85 (0.80-0.91)	< 0.001
0-2	1625 (20.65)	Reference		Reference		Reference
3	2512 (31.91)	0.94 (0.81-1.01)	0.444	0.95 (0.81-1.10)	0.466	0.88 (0.74-1.05)	0.145
4	2631 (33.43)	0.78 (0.67-0.91)	0.001	0.78 (0.67-0.91)	0.002	0.70 (0.59-0.84)	< 0.001
5	1103 (14.01)	0.76 (0.62-0.91)	0.004	0.76 (0.63-0.92)	0.005	0.65 (0.52-0.80)	< 0.001
P for trend			0.001		0.001		< 0.001

¹Model 1: Adjusted for age and gender.

²Model 2: Adjusted for age, gender, physical exercise, smoking, education.

³Model 3: Adjusted for age, gender, physical exercise, smoking, education, body mass index, hypertension and diabetes.

Data are presented as the logistic regression index (95%CI).

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Citation: Yu QT, Lin YY, Gui ZH, Duan HL, Yang JJ, Meng Y, Peng XT, Liu L, Wan H, Shen J. Mediating roles of insulin resistance and inflammatory markers between healthy sleep scores and metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(21): 118057
URL: https://www.wjgnet.com/1007-9327/full/v32/i21/118057.htm
DOI: https://dx.doi.org/10.3748/wjg.v32.i21.118057

Yu QT, Lin YY, Gui ZH, Duan HL, Yang JJ, Meng Y, Peng XT, Liu L, Wan H, Shen J. Mediating roles of insulin resistance and inflammatory markers between healthy sleep scores and metabolic dysfunction-associated steatotic liver disease. World J Gastroenterol 2026; 32(21): 118057 [DOI: 10.3748/wjg.v32.i21.118057]

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