Association of Sleep Characteristics With Suspected Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) Risk Among Adults Attending a Community Health Center

Introduction: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a growing public health concern worldwide. Emerging evidence suggests that sleep disturbances may contribute to metabolic dysfunction and hepatic steatosis; however, data from rural Indian populations remain limited. This study assessed the association between sleep quality, sleep duration, and MAFLD risk among adults attending a rural primary healthcare facility in North India. Methods: A community-based analytical cross-sectional study was conducted among 550 adults attending the Rural Health Training Center of a tertiary care teaching institution in Haryana, India. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and participants were classified as having good (PSQI ≤ 5) or poor (PSQI > 5) sleep quality. Sleep duration was categorized as <6 hours, 6-8 hours, or >8 hours per night. MAFLD risk was estimated using a validated non-laboratory risk assessment score and categorized as low (<8 points) or high (≥8 points). Multivariable logistic regression was performed to evaluate the association of sleep-related factors with high MAFLD risk after adjustment for sex, smoking status, alcohol consumption, and dietary pattern. Results: The mean age of participants was 42.6 ± 13.5 years, and 56.4% were female. Poor sleep quality was observed in 210 (38.2%) participants, while 174 (31.6%) were classified as having high MAFLD risk. High MAFLD risk was significantly more common among participants with poor sleep quality than among those with good sleep quality (47.1% vs. 22.1%; p < 0.001). Participants sleeping <6 hours per night had the highest prevalence of high MAFLD risk (44.6%) compared with those sleeping 6-8 hours (28.5%) or >8 hours (26.4%) (p = 0.002). After adjustment for sex, smoking status, alcohol consumption, and dietary pattern, poor sleep quality (adjusted odds ratio (AOR): 2.68; 95% CI: 1.82-3.95) and short sleep duration (AOR: 1.71; 95% CI: 1.10-2.64) remained independently associated with high MAFLD risk. The PSQI score demonstrated acceptable discriminatory ability for identifying high MAFLD risk (AUC = 0.71; 95% CI: 0.65-0.77). Conclusions: Poor sleep quality and short sleep duration were independently associated with high MAFLD risk among adults in a rural North Indian primary care setting. These associations remained significant after adjustment for selected demographic and lifestyle factors. Incorporating sleep assessment into routine metabolic risk screening may provide a simple, low-cost strategy for identifying individuals at increased risk of MAFLD.