Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) and Advanced Fibrosis among Subjects without Type 2 Diabetes (T2D)

Background: NAFLD is highly prevalent in patients with T2D. The prevalence of NAFLD in nondiabetics (ND) is not known. Aim: Assess the prevalence of NAFLD in ND subjects in the US. Methods: Data from NHANES 2017-2020 were used. NAFLD was determined by transient elastography with a CAP of ≥285 dB/m without other causes of liver disease. Significant fibrosis (SF) definition was liver stiffness measurement (LSM) >8.0 kPa and advanced fibrosis (AF) definition was LSM>13.1 kPa. Prediabetes (Pre-D) definition was fasting glucose of 100-125 mg/dL or HbA1c of 5.7%-6.5% in T2D absence. ND definition was not having T2D or Pre-D. Results: Among 5,142 patients (mean age 51.5 years, 19.4% T2D, 35.2% Pre-D and 45.4% ND). The prevalence of NAFLD among T2D, Pre-D and ND was 67.7%, 40.0% and 24.6%. As compared to Pre-D and T2D, ND patients were younger (45.6 years vs 53.4 and 62.2 years), more likely to be female (51.4% vs 43.9% and 45.3%) and less metabolically unhealthy [hypertension: 39.7% vs 56.9% and 83.9%, hyperlipidemia: 63.6%, 73.3%, and 89.0% and HOMA-IR > 2.5: 26.5%, 54.8%, and 84.9% (all p<.001)]. The prevalence of SF and AF among NAFLD with ND, Pre-D and T2D were 17.1% and 4.9%, 16.0% and 6.2%, and 32.4% and 11.8%, respectively. Factors associated with higher risk of AF varied by T2D status (Table). Conclusions: NAFLD can occur in nondiabetics and associated with insulin resistance and elevated CRP. Disclosure P. Golabi: None. J.M. Paik: None. A. Kumar: None. N. Gundurao: None. K. Cusi: Research Support; Echosens, Inventiva. Consultant; Poxel SA. Research Support; LabCorp, Zydus. Consultant; Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns. Z. Younossi: Consultant; AbbVie Inc., BMS, Gilead Sciences, Inc., Novo Nordisk, Merck & Co., Inc., Quest Diagnostics, Siemens, Intercept Pharmaceuticals, Inc., Viking Therapeutics.