Prevalence and Predictors of Hepatic Steatosis Among Adult Population With Prediabetes: Data From NHANES 2017–2018

Previous studies have examined the prevalence of hepatic steatosis in patients with diabetes but few studies examined the relationship between hepatic steatosis and prediabetes. The purpose of this study was to examine the relationship between hepatic steatosis and prediabetes in a representative sample of the U.S. adult 20 years and older. Data from 5,492 participants in the National Health and Nutrition Examination Survey (NHANES) 2017–2018 were analyzed. Participants were considered normal if they have hemoglobin A1c (HbA1c) <5.7%, have prediabetes if their HbA1c was 5.7% to 6.4% and had diabetes if their HbA1c was > 6.5. Hepatic steatosis was diagnosed using fibroscan. We analyzed the data using descriptive, bivariate Chi square, and multiple logistic regression to determine the association between diabetes status, prediabetes status and hepatic steatosis, adjusting for confounding variables and considering the design and sample weights. Of the 5,492 participants, 8.5% had diabetes and 22.6% had prediabetes. The prevalence of hepatic steatosis was 70% among population with diabetes, 46% among the prediabetes group, and 21% in the normal group (p<0.05). In the adjusted logistic regression model, relative to the normal group, patients with diabetes were four times more likely to have hepatic steatosis relative to normal group (adjusted odds ratio [AOR]=4.0, 95% confidence level [CI]=2.4–6.8, p<0.05). Population with prediabetes were two times more likely to have hepatic steatosis relative to the normal group (AOR=2.1, 95% CI=1.6–2.6, p<0.05). Among the population with prediabetes, the predictors of hepatic steatosis were age 50–65 years old relative to 20–34 years old (AOR=1.9, 95% CI=1.1–3.2, p<0.05), overweight (AOR=5.4, 95% CI=2.5–11.8, p<0.05), obese (AOR=16.6, 95% CI=7.2–38.0, p<0.05) relative to normal body mass index, and high triglyceride level (>=200 mg/dL) (AOR=4.2, 95% CI=2.6–6.6, p<0.05) versus normal (<=150 mg/dL). Blacks with prediabetes were 40% less likely to have hepatic steatosis relative to Whites (AOR=0.6, 95% CI=0.4–0.9, p<0.05). Our study indicates that the prevalence of hepatic steatosis is higher in diabetic and prediabetes groups compared to normal group. In addition, those with prediabetes had more than two times higher chance of having hepatic steatosis relative to the normal group. Further longitudinal studies are needed to explore the causal relation between prediabetes and hepatic steatosis among the adult population. Grant numbers: R01MD012579, R24DA017298, U54MD007598, S21MD000103, UL1TR001881