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February 14, 2026Open Access

Association between nonalcoholic fatty liver disease and stroke: a cross-sectional study

SZShuai ZhouKunming University of Science and Technology GMGe MangCapital Medical University HZHu ZhouKunming University of Science and Technology

Puntos clave

This study assesses the link between nonalcoholic fatty liver disease (NAFLD) and stroke in a national adult cohort.
Conducted a cross-sectional analysis using NHANES data from 1999 to 2020.
Defined NAFLD using the United States Fatty Liver Index.
Applied multivariable logistic regression models adjusting for various factors.
Performed subgroup and sensitivity analyses to check the robustness of findings.
40.426% of participants had NAFLD, with higher stroke prevalence in this group (4.087% vs. 2.215%).
NAFLD was significantly associated with stroke in both unadjusted and demographic-adjusted models.
The association lost statistical significance when adjusting for metabolic syndrome.
Significant associations were found in specific age groups and individuals without hypertension.

Resumen

Background: Emerging evidence suggests a potential association between nonalcoholic fatty liver disease (NAFLD) and stroke risk, but data from US outpatient populations remain inconclusive. This study aimed to evaluate this association in a nationally representative adult cohort. Methods: A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) cycles 1999–2020. NAFLD was defined by the United States Fatty Liver Index (≥30). Stroke history was self-reported. Multivariable logistic regression models adjusted for sociodemographic factors, metabolic syndrome, and survey weights. Subgroup and sensitivity analyses were performed to assess robustness. Results: Among 13 422 participants (mean age 47.141 years; 50.948% female), 40.426% had NAFLD. Stroke prevalence was significantly higher in the NAFLD group (4.087 vs. 2.215%, P < 0.001). NAFLD was independently associated with stroke in unadjusted (OR 1.804, 95% CI 1.508–2.157, P < 0.001) and demographically adjusted models (OR 1.420, 95% CI 1.171–1.721, P < 0.001). In Model 3, after adjusting for metabolic syndrome, the association was not statistically significant (OR 1.193, 95% CI 0.958–1.485, P = 0.116). In the subgroup analysis, the association between the two diseases was significant in participants aged 50–65 years (OR 1.654, 95% CI 1.044–2.622) and those without hypertension (OR 2.077, 95% CI 1.211–3.328). The connection remained significant in models applying inverse probability weighting (OR 1.611, 95% CI 1.400–1.853, P < 0.001) and continued to exist after non-Hispanic Black participants were excluded (OR 1.290, 95% CI 1.006–1.656, P = 0.045). Conclusions: This study reveals a significant association between NAFLD and stroke, especially in adults aged 50–65 and those without hypertension. These findings suggest that NAFLD is associated with vascular risk; further prospective research is needed to determine whether it should be incorporated into cardiovascular risk assessments. Longitudinal research is needed to confirm whether treating NAFLD reduces stroke incidence.

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