Circadian syndrome and incident non-neoplastic digestive disease in middle-aged and older Chinese adults: a prospective cohort study
- 1Department of Gastroenterology, 923th Hospital of PLA Joint Logistics Support Force, Nanning, China
Abstract
BackgroundCircadian syndrome (CircS) comprises metabolic abnormalities, short sleep, and depressive symptoms, and is associated with cardiovascular, liver, and lung diseases and mortality; evidence on digestive disease is scarce. We assessed its association with incident non-neoplastic digestive disease in Chinese adults.
MethodsIn this prospective analysis of the China Health and Retirement Longitudinal Study (CHARLS), we included 2011 baseline participants aged [≥]45 years free of digestive disease, with follow-up to 2018. CircS ([≥]4 of 7 components) was analysed as a continuous score and as a binary exposure. Cox models estimated hazard ratios (HRs) adjusting for demographic factors, BMI, smoking, and alcohol use. We did dose-response, component, subgroup, and sensitivity analyses; hs-CRP mediation was explored.
Findings907 (19{middle dot}0%) of 4 771 participants developed digestive disease over a median 84 months. Each additional CircS component raised the risk by 9{middle dot}1% (HR 1{middle dot}091, 95% CI 1{middle dot}041-1{middle dot}144, P<0{middle dot}001); CircS positivity (36{middle dot}1%) was associated with a 25{middle dot}7% higher risk (HR 1{middle dot}257, 1{middle dot}084-1{middle dot}456, P=0{middle dot}002). Risk rose approximately linearly to about 70% higher at 5-7 components. Short sleep (HR 1{middle dot}178, 1{middle dot}017-1{middle dot}365) and depressive symptoms (HR 1{middle dot}570, 1{middle dot}367-1{middle dot}803) were the only independently associated components; no metabolic component was associated. Results were robust across sensitivity analyses; hs-CRP did not mediate the association.
InterpretationCircS is associated with incident non-neoplastic digestive disease, driven by its circadian-emotional rather than metabolic components. Sleep and mood may be targets for prevention.
FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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BibTeX
@misc{liu2026circadian,
title = {{Circadian syndrome and incident non-neoplastic digestive disease in middle-aged and older Chinese adults: a prospective cohort study}},
author = {L. Liu and L. Zhao and C. Li and Y. Geng},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.24.26363842},
url = {https://www.medrxiv.org/content/10.64898/2026.09.24.26363842v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Circadian syndrome and incident non-neoplastic digestive disease in middle-aged and older Chinese adults: a prospective cohort study
AU - L. Liu
AU - L. Zhao
AU - C. Li
AU - Y. Geng
PY - 2026
DA - 2026/09/24
PB - medRxiv
DO - 10.64898/2026.09.24.26363842
UR - https://www.medrxiv.org/content/10.64898/2026.09.24.26363842v1
AB - BackgroundCircadian syndrome (CircS) comprises metabolic abnormalities, short sleep, and depressive symptoms, and is associated with cardiovascular, liver, and lung diseases and mortality; evidence on digestive disease is scarce. We assessed its association with incident non-neoplastic digestive disease in Chinese adults. MethodsIn this prospective analysis of the China Health and Retirement Longitudinal Study (CHARLS), we included 2011 baseline participants aged [≥]45 years free of digestive disease, with follow-up to 2018. CircS ([≥]4 of 7 components) was analysed as a continuous score and as a binary exposure. Cox models estimated hazard ratios (HRs) adjusting for demographic factors, BMI, smoking, and alcohol use. We did dose-response, component, subgroup, and sensitivity analyses; hs-CRP mediation was explored. Findings907 (19{middle dot}0%) of 4 771 participants developed digestive disease over a median 84 months. Each additional CircS component raised the risk by 9{middle dot}1% (HR 1{middle dot}091, 95% CI 1{middle dot}041-1{middle dot}144, P<0{middle dot}001); CircS positivity (36{middle dot}1%) was associated with a 25{middle dot}7% higher risk (HR 1{middle dot}257, 1{middle dot}084-1{middle dot}456, P=0{middle dot}002). Risk rose approximately linearly to about 70% higher at 5-7 components. Short sleep (HR 1{middle dot}178, 1{middle dot}017-1{middle dot}365) and depressive symptoms (HR 1{middle dot}570, 1{middle dot}367-1{middle dot}803) were the only independently associated components; no metabolic component was associated. Results were robust across sensitivity analyses; hs-CRP did not mediate the association. InterpretationCircS is associated with incident non-neoplastic digestive disease, driven by its circadian-emotional rather than metabolic components. Sleep and mood may be targets for prevention. FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
ER -