Advanced International Journal for Research

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Association of Non-Alcoholic Fatty Liver Disease with Early Atherosclerotic Markers in Non-Obese Adults: A Cross-Sectional Study

Author(s) Sarthak Dahiya, Sirjana Kaur Dhaliwal, Namrata, Jeyshri Bala Subramaniam, Lakshmishree Shanthi Sathyavenkatesan
Country India
Abstract Background: Non-alcoholic fatty liver disease (NAFLD) is usually thought of as a disease of excess body weight, but a good number of people with NAFLD in South Asia turn out to have a body mass index (BMI) that is well within the normal range. Whether NAFLD raises vascular risk on its own, separate from overall body weight, in such non-obese adults has not been looked at closely enough.
Objective: To find out whether NAFLD is associated with early markers of atherosclerosis, namely carotid intima-media thickness (CIMT), carotid plaque, pulse wave velocity (PWV), and brachial flow-mediated dilation (FMD), in adults who are not obese.
Methods: This cross-sectional study was done on 150 non-obese adults (BMI 19.1 to 24.9 kg/m²), 75 with NAFLD confirmed on ultrasound and 75 without. Anthropometric, biochemical, and vascular measurements were compared between the two groups, and a multivariable logistic regression was used to check whether NAFLD remained linked to early atherosclerosis after adjusting for age, sex, BMI, waist circumference, glycaemic status, hypertension, and hs-CRP.
Results: Adults with NAFLD had a clearly higher CIMT (0.74 vs 0.53 mm), higher PWV (9.25 vs 7.05 m/s), and lower FMD (7.92 vs 12.95%) than those without NAFLD, all with p<0.001, even though BMI and waist circumference were similar in both groups. Early atherosclerosis was seen in 54 of 75 (72.0%) NAFLD participants against 6 of 75 (8.0%) of those without NAFLD (p<0.001). CIMT and PWV rose, and FMD fell, in a stepwise fashion across NAFLD grades (all trend p<0.001). NAFLD stayed independently linked to early atherosclerosis on multivariable analysis (adjusted odds ratio 48.8, 95% CI 9.1 to 260.4, p<0.001), while BMI and waist circumference showed no independent link at all.
Conclusion: Among non-obese adults, NAFLD is strongly and independently tied to early atherosclerotic change, largely separate from overall or central body fat. Fatty liver, rather than BMI by itself, may be the better early warning sign of cardiovascular risk in lean people.
Keywords Non-alcoholic fatty liver disease; non-obese; carotid intima-media thickness; pulse wave velocity; flow-mediated dilation; subclinical atherosclerosis
Field Medical / Pharmacy
Published In Volume 7, Issue 4, July-August 2026
Published On 2026-07-24
DOI https://doi.org/10.63363/aijfr.2026.v07i04.7401
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