PREVALENCE OF MASH, OBESITY AND DIABETES IN US ADULTS: NHANES 2017 TO MARCH 2020 AND AUGUST 2021 TO AUGUST 2023
Author(s)
Christina M. Parrinello, PhD, MPH1, Yestle Kim, MSc, PharmD1, Karen Phillips, PharmD, BCPS1, Suneil M. Hosmane, PhD1, John C. O'Donnell, MPP, PhD1, Anthony Martinez, MD2;
1Madrigal Pharmaceuticals, Inc, West Conshohocken, PA, USA, 2University at Buffalo, Buffalo, NY, USA
1Madrigal Pharmaceuticals, Inc, West Conshohocken, PA, USA, 2University at Buffalo, Buffalo, NY, USA
OBJECTIVES: Previous studies have reported the prevalence of the overlap of metabolic dysfunction-associated steatohepatitis (MASH) with obesity and diabetes separately. This study evaluated the overlap among all three in a single study representative of United States (US) adults, focusing on fibrosis stages 2-3 (F2-F3), which are currently indicated for MASH therapies.
METHODS: Analyses used the fasting subsamples in the cross-sectional NHANES 2017-March 2020 and August 2021-August 2023 cycles. Metabolic dysfunction-associated steatotic liver disease (MASLD) was defined using controlled attenuation parameter (CAP) ≥288 dB/m and no other cause of liver disease (alcohol consumption, hepatitis B/C). Within MASLD, MASH was defined as F1 (liver stiffness measurement [LSM] 6 to <8kPa), F2 (8 to <10 kPa), F3 (10 to <20kPa) and F4 (≥20 kPa; and dichotomized as probable compensated [F4c] [platelets ≥150×10⁹/L and albumin ≥3.5 g/dL and total bilirubin <2 mg/dL] and decompensated [F4d] [platelets <150×10⁹/L or albumin <3.5 g/dL or total bilirubin ≥2 mg/dL]). Diabetes was defined as self-reported, HbA1c ≥6.5%, or fasting plasma glucose ≥126 mg/dL; obesity was defined as BMI ≥30 kg/m2. Prevalences and 95% confidence intervals (CIs) were calculated. Survey weights accounted for the complex survey design.
RESULTS: Of the 5,540 non-pregnant complete case participants ≥20 years old, 39.1% (95% CI: 37.2, 41.1) had obesity, 15.0% (95% CI: 13.6, 16.5) had diabetes and 30.1% (95% CI: 28.0, 32.2) had MASLD/MASH (8.0% F1, 2.0% F2, 2.7% F3 and 0.7% F4 [0.5% F4c, 0.2% F4d]). Among the 4.7% with MASH F2-F3 (mean age 53 years, 53% male, 66% non-Hispanic white), 5.7% had diabetes only, 38.9% obesity only, 46.3% both and 9.0% neither.
CONCLUSIONS: Among US adults meeting noninvasive test criteria for MASH with moderate-to-advanced fibrosis, the majority had coexisting obesity and/or diabetes; however, nearly 10% had neither, highlighting a distinct subset who may uniquely benefit from liver-directed therapy.
METHODS: Analyses used the fasting subsamples in the cross-sectional NHANES 2017-March 2020 and August 2021-August 2023 cycles. Metabolic dysfunction-associated steatotic liver disease (MASLD) was defined using controlled attenuation parameter (CAP) ≥288 dB/m and no other cause of liver disease (alcohol consumption, hepatitis B/C). Within MASLD, MASH was defined as F1 (liver stiffness measurement [LSM] 6 to <8kPa), F2 (8 to <10 kPa), F3 (10 to <20kPa) and F4 (≥20 kPa; and dichotomized as probable compensated [F4c] [platelets ≥150×10⁹/L and albumin ≥3.5 g/dL and total bilirubin <2 mg/dL] and decompensated [F4d] [platelets <150×10⁹/L or albumin <3.5 g/dL or total bilirubin ≥2 mg/dL]). Diabetes was defined as self-reported, HbA1c ≥6.5%, or fasting plasma glucose ≥126 mg/dL; obesity was defined as BMI ≥30 kg/m2. Prevalences and 95% confidence intervals (CIs) were calculated. Survey weights accounted for the complex survey design.
RESULTS: Of the 5,540 non-pregnant complete case participants ≥20 years old, 39.1% (95% CI: 37.2, 41.1) had obesity, 15.0% (95% CI: 13.6, 16.5) had diabetes and 30.1% (95% CI: 28.0, 32.2) had MASLD/MASH (8.0% F1, 2.0% F2, 2.7% F3 and 0.7% F4 [0.5% F4c, 0.2% F4d]). Among the 4.7% with MASH F2-F3 (mean age 53 years, 53% male, 66% non-Hispanic white), 5.7% had diabetes only, 38.9% obesity only, 46.3% both and 9.0% neither.
CONCLUSIONS: Among US adults meeting noninvasive test criteria for MASH with moderate-to-advanced fibrosis, the majority had coexisting obesity and/or diabetes; however, nearly 10% had neither, highlighting a distinct subset who may uniquely benefit from liver-directed therapy.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH6
Topic
Epidemiology & Public Health
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)