Short sleep duration and its Determinants in MASLD and Non-MASLD: A Population-Based Cohort Study from Iran

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) affects about 25–30% of adults and is linked to obesity, diabetes, and metabolic syndrome. Sleep disturbance, especially short sleep duration, is common in this population. This study examined the association between MASLD and short sleep. Methods: We analyzed 10,019 adults (35–70 years) from the Fasa Adult Cohort Study, part of the PERSIAN cohort. MASLD was identified by the Fatty Liver Index (FLI). Sleep duration was self-reported, with short sleep defined as <6 hours per night. Logistic regression identified factors associated with short sleep. Results: Among 10,019 participants, 2,601 (25.9%) had MASLD. Compared with non-MASLD individuals, they had higher BMI, blood pressure, metabolic markers, and more diabetes and hypertension. In non-MASLD, short sleep was associated with age, SGPT, lupus, headache, dizziness, and back pain, while higher HDL and WSI were protective. In MASLD, short sleep was linked to age and osteoporosis, whereas higher HDL and food regurgitation were protective. Conclusion: Short sleep was common in both MASLD and non-MASLD adults. Age and low HDL consistently contributed, while other factors differed between groups, highlighting the multifactorial nature of sleep disturbance in MASLD.