Association of estimated pulse wave velocity with non-alcoholic fatty liver disease in multiple cohorts

Diagnosing non-alcoholic fatty liver disease (NAFLD) via ultrasound faces cost and accessibility challenges. We assessed whether estimated pulse wave velocity (ePWV), a measure of arterial stiffness, could serve as an accessible diagnostic marker for NAFLD. In two large cohorts (NAGALA, n = 14,251; NHANES, n = 12,767), higher ePWV independently predicted NAFLD, with top-quartile participants showing significantly higher odds (OR = 1.85, 1.40-2.45 for NAGALA; OR = 3.05, 1.67-5.59 for NHANES). A non-linear relationship was observed: Below the inflection point, each 1 m/s increase in ePWV raised NAFLD risk by 33.6% (NAGALA) and 57% (NHANES), plateauing thereafter. These findings demonstrate that ePWV is independently associated with increased NAFLD risk, supporting its potential utility for early risk stratification.