Risk Factors and Diagnostic Markers for Fatty Liver and Metabolic Syndrome Among Young Adults: Insights from a Community-Based Investigation

Background There is a growing incidences of hepatosteatosis and metabolic syndrome in young adults worldwide. This study aimed to address these gaps by systematically evaluating simple indices in clinical practice to strengthen the prediction and prevention of hepatosteatosis in young adults. Methods Of the 4,067 young adults (20–40 years old) who underwent a community health check-up between March and December 2022, 3,796 (93%) were eligible for analysis. The characteristics of the participants with and without moderate-to-severe fatty liver were compared using SPSS 26 with two-tailed tests. Multivariable logistic regression model and AUC were performed to assess the correlation between fatty liver and associated factors in this study. Results Those prevalence was significant, with 24.9%, 19.8%, and 7.1% of the participants having mild, moderate, and severe fatty liver, respectively. The alanine transaminase/aspartate transaminase ratio (ALT/AST) showed a good diagnostic performance for fatty liver (AUC = 79.1%, 95% CI = 77.8 to 80.4%) and cutoff value > 1.3 for ALT/AST ratio, whereas blood cell parameters were less effective. Multivariable analysis identified male (odds ratio [OR] 1.44, 95% CI 1.20–1.73), elder age (OR 1.06, 95% CI 1.05–1.08), ALT/AST > 1.3 (OR 6.13, 95% CI 5.15–7.30) associated with a higher risk of significant fatty liver while smoking and betel chewing additionally associated with metabolic syndrome. By contrast, regular exercise (OR 0.79, 95% CI 0.64–0.93) and dental scaling (OR 0.81, 95% CI 0.69–0.96) were significantly associated with a lower risk. Conclusions Beyond male, age, education, exercise and dental scaling, our study found ALT/AST ratios > 1.3 might be significantly correlated with moderate-to-severe hepatosteatosis and metabolic syndrome among young adults. Further large-scale and long-term observations are required to verify these findings and understand the underlying mechanisms.