Temporal trends in hepatic steatosis and its risk factors among young adults: A comparative cohort study

Metabolic-dysfunction-associated steatotic liver disease (MASLD) is increasingly affecting younger populations worldwide, yet early-phase data from low-risk, health-literate groups remain limited. This study aimed to evaluate temporal changes in the prevalence and risk factors of hepatic steatosis among medical students across two cohorts 6 years apart.

We enrolled 489 medical students from King Saud University across two cross-sectional cohorts (2017: n = 301; 2023: n = 188). All underwent noninvasive liver assessment using transient elastography (FibroScan®, controlled attenuation parameter [CAP] ≥248 dB/m indicating steatosis). Demographic, anthropometric, and lifestyle data were collected via standardized questionnaires. Logistic regression identified independent steatosis predictors.

The overall prevalence of hepatic steatosis was 21.1%, increasing from 18.6% in 2017 to 25.0% in 2023 (P = 0.092). Students with steatosis had significantly higher BMI, waist circumference, and obesity prevalence (all P < 0.01). Advanced fibrosis (≥F2) was rare (1.6%). Male sex and central adiposity were strongly associated with steatosis. In the 2023 cohort, strength training was less common among those with steatosis (34.8% vs 69.4%, P = 0.002). Frequent fast-food intake and reduced consumption of antioxidant-rich foods were associated with steatosis in univariable analysis but lost significance after adjustment. A self-reported history of fatty liver remained the only independent predictor (adjusted OR = 6.28; 95% CI: 1.14-47.8; P = 0.042).

This cross-sectional comparative study of two medical student cohorts, 6 years apart, reveals a rising prevalence of hepatic steatosis among young adults. Despite low rates of advanced fibrosis, many showed early metabolic risk markers. These findings highlight the need for early screening and preventive strategies targeting youth at risk for MASLD.