Prevalence and Severity of Hepatic Steatosis and Fibrosis Across Glycemic Categories Among Patients Attending a Tertiary Care Hospital: A FibroScan-Based Cross-Sectional Study

Introduction: Hepatic steatosis is strongly associated with metabolic dysfunction and is common among individuals with prediabetes and type 2 diabetes mellitus (T2DM).Noninvasive assessment using controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) may help characterize hepatic steatosis and fibrosis risk.This study evaluated the distribution and severity of hepatic steatosis and liver fibrosis across glycemic categories in patients undergoing FibroScan assessment at a tertiary care hospital.Methods: This retrospective cross-sectional observational study included 350 adults who underwent FibroScan assessment at a tertiary care hospital.We assessed hepatic steatosis and liver stiffness using the FibroScan Compact 530 (Echosens, Paris, France).We recorded the probe type (M or XL) where available.We performed examinations according to the manufacturer's recommendations after the required fasting period.We used LSM (kPa) to assess hepatic fibrosis and CAP (dB/m) to assess hepatic steatosis.We assigned steatosis and fibrosis categories using prespecified CAP and LSM thresholds from the clinical FibroScan protocol.We categorized participants as nondiabetic, prediabetic, or with T2DM.In addition to unadjusted chi-square analyses, multivariable ordinal logistic regression assessed associations between glycemic category and increasing steatosis and fibrosis severity, adjusting for age, sex, BMI, dyslipidemia, alcohol use, alanine aminotransferase (ALT), and relevant antidiabetic medications.We assessed the proportional-odds assumption and used multinomial logistic regression when it was not met.Adjusted odds ratios (aORs), 95% confidence intervals (CIs), and model diagnostics were reported.Results: Among 350 participants, 82 were nondiabetic, 102 prediabetic, and 166 had T2DM.Steatosis severity differed significantly across glycemic categories (χ² = 28.96,df = 6, p < 0.001).Severe steatosis (S3) occurred in 2.4% of nondiabetic, 6.9% of prediabetic, and 18.7% of T2DM participants.After adjustment, prediabetes (aOR: 2.22, 95% CI: 1.26-3.94;p = 0.006) and T2DM (aOR: 3.58, 95% CI: 1.58-8.14;p = 0.002) were independently associated with greater steatosis severity compared with nondiabetic status.Higher BMI and ALT were also independently associated with greater steatosis severity.Fibrosis distribution did not differ significantly across glycemic groups (χ² = 3.49, df = 4, p = 0.480).In the adjusted fibrosis model, prediabetes was not significantly associated with greater fibrosis severity (aOR: 1.09, 95% CI: 0.36-3.25;p = 0.880), while T2DM showed higher but nonsignificant odds (aOR: 2.98, 95% CI: 0.81-10.96;p = 0.102).Age and ALT were independently associated with greater fibrosis severity.Conclusion: In this tertiary care FibroScan-evaluated cohort, hepatic steatosis was increasingly severe across worsening glycemic categories, with the greatest burden observed among participants with T2DM.The association between glycemic status and steatosis remained significant after adjustment for major metabolic and clinical covariates, whereas the adjusted association between glycemic status and fibrosis was not statistically significant.These findings support using noninvasive liver assessment for metabolic risk stratification in individuals with prediabetes and T2DM, while recognizing that transient elastography does not establish a histological diagnosis of steatohepatitis.