Association of circadian-metabolic syndrome with incident chronic liver disease in middle-aged and elderly Chinese adults: a prospective cohort study on mediation by cardiovascular disease.

BACKGROUND: This study aimed to investigate the association between circadian-metabolic syndrome (CircS) and chronic liver disease (CLD) among middle-aged and elderly Chinese people, and to evaluate the mediating role of cardiovascular disease (CVD) in this relationship. METHODS: The study included data from 6082 Chinese individuals from the China Health and Retirement Longitudinal Study (CHARLS). None of them had CLD at the time of the baseline survey (2011), and multifactorial COX regression models were used to analyse the association between CircS and new-onset CLD. In addition, the mediating effect of CVD between CircS and CLD was analysed. RESULTS: A total of 588 (9.67%) of 6082 participants developed CLD during follow-up. The hazard ratio (HR) for new-onset CLD in participants diagnosed with CircS compared with those without CircS was 1.33 (95% CI 1.12-1.57).The risk of new-onset CLD increased 1.14-fold (95% CI 1.08-1.20) for each additional component of the CircS component. The CVD was found to mediate the association between CircS and incident CLD compared with participants without CircS, proportions mediated were 20.6%. For each additional component of the CircS component, the CVD was found to mediate the association between CircS and incident CLD, proportions mediated were 10.40%. CONCLUSION: CircS is associated with an increased risk of incident CLD in the middle-aged and elderly Chinese population. CVD may play a certain mediating role in the relationship between CircS and CLD.