# Association of Circadian Rhythms With the Risk of Chronic Liver Disease: Findings From a Large Prospective Study

## TL;DR

Disrupted circadian rhythms are linked to a higher risk of chronic liver diseases, including liver fat accumulation and inflammation, based on a large study of 94,006 people.

## Contribution

This study identifies disrupted circadian rhythms as a novel risk factor for chronic liver disease progression.

## Key findings

- Lower circadian rhythm amplitude is associated with increased risk of steatotic liver disease, cirrhosis, and hepatocellular carcinoma.
- Circadian rhythm amplitude shows a dose-response relationship with liver fat content and inflammation.
- The association between circadian rhythms and liver disease remains significant after adjusting for genetic risk scores.

## Abstract

The liver clock of hepatocytes is actively involved in regulating their proliferation, metabolism, oxidative stress response, and chronic liver disease (CLD) progression. However, the relationship between circadian rhythms and CLD remains poorly understood. This study aimed to examine the associations of circadian rhythms with metabolic dysfunction-associated steatotic liver disease, cirrhosis, and hepatocellular carcinoma.

This study included 94,006 participants from the UK Biobank. Circadian rhythms were assessed by a 7-day accelerometer by relative amplitude (RA), which indicates the difference between the most and least active periods. Cox regression and restricted cubic splines were used to evaluate the associations between circadian rhythms and CLD. Liver fat content and hepatic inflammation were additionally assessed using magnetic resonance imaging-measured proton density fat fraction and corrected T1 scores.

During the follow-up of 9.8 years, individuals in the lowest quartile of RA had higher hazard ratios of 1.54 (95% CI: 1.32–1.78) for metabolic dysfunction-associated steatotic liver disease, 1.79 (95% CI: 1.38–2.32) for cirrhosis, and 1.65 (95% CI: 1.02–2.76) for hepatocellular carcinoma than those in the highest third quartile did. A dose‒response relationship between RA and CLD was observed (P < 0.001). Furthermore, there was a joint and independent relationship between polygenic risk scores, RA, and the CLD. RA was negatively correlated with proton density fat fraction and corrected T1 scores, demonstrating a dose‒response pattern (P < 0.001).

Abnormal circadian rhythm is significantly associated with the risk of CLD, potentially due to increased liver fat content and hepatic inflammation. Therefore, disrupted circadian rhythms may be a risk factor for liver disease and represent a potential target for intervention.