Date of Conferral

8-7-2025

Degree

Ph.D.

School

Public Health

Advisor

Zin Htway

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly nonalcoholic fatty liver disease-related liver fibrosis) is a growing public health problem in the United States. The purpose of this study was to assess the prevalence of MASLD-related advanced fibrosis in the United States and assess whether type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) were independent risk factors for MASLD-related advanced fibrosis. This study was a quantitative cross-sectional analysis of the National Health and Nutrition Examination Survey data from 2011 to 2020, grounded in the social ecological theory. Participants (N = 21,829) were included if they were ≥18 years, excluded if they had positive hepatitis serology, were HIV+, had extensive alcohol use, or if missing the fibrosis-4 index (FIB-4) score. Prevalence estimates were reported as percentages and frequencies, and stratified by age, race/ethnicity, sex, T2DM status, CVD status, and body mass index (BMI). Predictors of advanced fibrosis among patients were assessed using multiple binary logistic regression models. Study findings showed that MASLD-related advanced fibrosis had a 3.9% prevalence in the United States and that age, sex, race/ethnicity, BMI, T2DM status, and CVD status were correlated with MASLD-related advanced fibrosis. Furthermore, CVD status was independently related to MASLD-related advanced fibrosis after controlling for other factors. However, T2DM status was not shown to be independently related to MASLD-related advanced fibrosis. This study is significant as it provides insights to clinicians, payers, and policymakers on key factors that are associated with MASLD-related advanced fibrosis. Thus, potentially supports effective screening, diagnosis, and treatment strategies.

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