| Summary: | <h4>Background</h4>Non-alcoholic fatty liver disease (NAFLD), a common chronic liver disease, may progress to fibrosis, cirrhosis, hepatocellular carcinoma, and liver failure. But only a few cross-sectional studies have reported an association of NAFLD with working hours. This cohort study further examined the association between working hours and the development of NAFLD.<h4>Methods</h4>We included 79,048 Korean adults without NAFLD at baseline who underwent a comprehensive health examination and categorized weekly working hours into 35-40, 41-52, 53-60, and >60 hours. NAFLD was defined as the presence of fatty liver, in the absence of excessive alcohol use, as observed by ultrasound.<h4>Results</h4>During a median follow-up of 6.6 years, 15,095 participants developed new-onset NAFLD (incidence rate, 5.55 per 100 person-years). After adjustment for confounders, the hazard ratios (95% confidence interval) for the development of NAFLD in 41-52, 53-60, and >60 working hours compared with that in 35-40 working hours were 1.07 (1.02-1.13), 1.06 (1.00-1.13), and 1.13 (1.05-1.23), respectively. Furthermore, the association remained significant after confounders were treated as time-varying covariates.<h4>Conclusion</h4>In this large-scale cohort, long working hours, especially >60 working hours a week, were independently associated with incident NAFLD. Our findings indicate that long working hours are a risk factor for NAFLD.
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