Association of prediabetes phenotypes with metabolic dysfunction-associated fatty liver disease and liver fibrosis: a population-based study

Background: Prediabetes comprises three heterogeneous glucometabolic phenotypes and is associated with an increased risk of metabolic dysfunction-associated fatty liver disease (MAFLD). However, the association of different prediabetes phenotypes with the presence of MAFLD and liver fibrosis remains underexplored. Objectives: To examine the association of different prediabetes phenotypes with MAFLD and liver fibrosis. Design: Population-based cross-sectional study. Methods: Prediabetes was stratified as an isolated defect (impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or impaired hemoglobin A1c (IA1c)), two defects (IFG + IGT, IFG + IA1c, or IGT + IA1c), or all three defects (IFG + IGT + IA1c). Hepatic steatosis and liver fibrosis were assessed by vibration-controlled transient elastography. Multivariate logistic regression analysis was conducted to estimate the odds ratio (OR) and 95% confidence interval (CI) for different prediabetes phenotypes associated with MAFLD and liver fibrosis. Results: A total of 1599 subjects (394 with normal glucose tolerance (NGT) and 1205 with prediabetes) were included. The prevalence of MAFLD and liver fibrosis was higher in prediabetes than in NGT. The odds of MAFLD in prediabetes with two or three glucometabolic defects were increased compared with those with a single glucometabolic defect, with insulin resistance as a possible mediator. Compared with isolated IA1c, isolated IGT had an increased prevalence of MAFLD ( p < 0.05). Moreover, glucose-defined prediabetes had higher odds of MAFLD than HbA1c-defined prediabetes (OR 1.72, 95% CI 1.00–2.96). However, there was no significant difference in the odds of liver fibrosis across different prediabetes phenotypes ( p = 0.58). Conclusion: The odds of MAFLD but not liver fibrosis were increased with the increasing number of glucometabolic defects in participants with prediabetes. Trial registration: Not applicable.