Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2336–2338 | Cite as

Trends in Prevalence of Nonalcoholic Fatty Liver Disease in US Adults with Prediabetes

  • Phuc LeEmail author
  • Alexander Chaitoff
  • Michael B. Rothberg
  • Naim Alkhouri
  • Arthur McCullough
Concise Research Reports


Prediabetes affects 84 million US adults, more than 50% of whom will develop diabetes in 15 years.1 Once patients develop diabetes, up to 75% will have nonalcoholic fatty liver disease (NAFLD), and many of these will develop nonalcoholic steatohepatitis (NASH) and advanced fibrosis.2 However, the burden of NAFLD and associated comorbidities in patients with prediabetes is less well understood. We aimed to estimate the population-based trends in prevalence of concurrent suspected NAFLD, advanced fibrosis and NASH cirrhosis in US adults with prediabetes.


We conducted a cross-sectional, retrospective cohort analysis of the 2003–2014 National Health and Nutrition Examination Survey (NHANES). We included people aged ≥ 18 years who had a HbA1C from 5.7 to 6.4% or fasting plasma glucose from 100 to 125 mg/dL, or who were told they had prediabetes by a doctor but had never been diagnosed with diabetes. Patients with other causes of liver disease: viral hepatitis, excess...


Compliance with Ethical Standards

Conflict of Interest

Dr. Alkhouri received research funding from Gilead, Intercept, Allergan, Cirius, Madrigal, and Genfit which was not related to this study. Dr. McCullough was supported by grant U01 DK061732. All other authors have no conflicts of interest.


  1. 1.
    Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol 2015;3(11):866–875.CrossRefGoogle Scholar
  2. 2.
    Williams CD, Stengel J, Asike MI, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 2011;140(1):124–131.CrossRefGoogle Scholar
  3. 3.
    Sviklane L, Olmane E, Dzerve Z, Kupcs K, Pirags V, Sokolovska J. Fatty liver index and hepatic steatosis index for prediction of non-alcoholic fatty liver disease in type 1 diabetes. J Gastroenterol Hepatol 2018;33(1):270–276.CrossRefGoogle Scholar
  4. 4.
    Kabbany MN, Conjeevaram Selvakumar PK, Watt K, et al. Prevalence of Nonalcoholic Steatohepatitis-Associated Cirrhosis in the United States: An Analysis of National Health and Nutrition Examination Survey Data. Am J Gastroenterol 2017;112(4):581–587.CrossRefGoogle Scholar
  5. 5.
    Stefan N, Fritsche A, Schick F, Haring HU. Phenotypes of prediabetes and stratification of cardiometabolic risk. Lancet Diabetes Endocrinol 2016;4(9):789–798.CrossRefGoogle Scholar
  6. 6.
    Bae JC, Cho YK, Lee WY, et al. Impact of nonalcoholic fatty liver disease on insulin resistance in relation to HbA1c levels in nondiabetic subjects. Am J Gastroenterol 2010;105(11):2389–2395.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Phuc Le
    • 1
    Email author
  • Alexander Chaitoff
    • 2
  • Michael B. Rothberg
    • 1
  • Naim Alkhouri
    • 3
  • Arthur McCullough
    • 4
    • 5
  1. 1.Center for Value-based Care Research, Medicine Institute Cleveland ClinicClevelandUSA
  2. 2.Department of Internal MedicineBrigham and Women’s HospitalBostonUSA
  3. 3.Texas Liver InstituteSan AntonioUSA
  4. 4.Digestive Disease and Surgery Institute Cleveland ClinicClevelandUSA
  5. 5.Department of Inflammation and Immunity, Lerner Institute Cleveland ClinicClevelandUSA

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