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| Item Type: | Preprint |
|---|---|
| Title: | Prevalence and characteristics of steatotic liver disease in Germany - magnetic resonance imaging in the German National Cohort (NAKO) |
| Creators: |
von Itter, Marc-Nicolas  ORCID: https://orcid.org/0009-0005-2339-4270, Grune, Elena ORCID: https://orcid.org/0009-0001-8986-5670, Nonnenmacher, Tobias, Rach, Stefan ORCID: https://orcid.org/0000-0001-5241-0253, Flis, Martyna, Haueise, Tobias ORCID: https://orcid.org/0000-0002-1462-7539, Weiß, Jakob ORCID: https://orcid.org/0000-0002-0336-8519, Brenner, Hermann ORCID: https://orcid.org/0000-0002-6129-1572, Keil, Thomas ORCID: https://orcid.org/0000-0002-9108-3360, Roden, Michael ORCID: https://orcid.org/0000-0001-8200-6382, Schulze, Matthias B. ORCID: https://orcid.org/0000-0002-0830-5277, Schulz-Menger, Jeanette Esther ORCID: https://orcid.org/0000-0003-3100-1092, Völzke, Henry ORCID: https://orcid.org/0000-0001-7003-399X, Stefan, Norbert ORCID: https://orcid.org/0000-0002-2186-9595, Schlett, Christopher L. ORCID: https://orcid.org/0000-0002-1576-1481, Kauczor, Hans-Ulrich ORCID: https://orcid.org/0000-0002-6730-9462, Machann, Jürgen ORCID: https://orcid.org/0000-0002-4458-5886, Bamberg, Fabian ORCID: https://orcid.org/0000-0002-7460-3942, Nattenmüller, Johanna, Norajitra, Tobias ORCID: https://orcid.org/0000-0002-1788-8646 and Rospleszcz, Susanne ORCID: https://orcid.org/0000-0002-4788-2341
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| Abstract: | BACKGROUND AND AIMS: Steatotic liver disease (SLD) has high clinical and public health relevance. Robust population estimates of SLD and its subcategories are challenging due to the limitations of ultrasound measurements or non-invasive scores, particularly for low-grade steatosis. We aimed to quantify SLD prevalence using magnetic resonance imaging (MRI) in the population-based German National Cohort (NAKO). METHODS: Hepatic multi-echo Dixon MRI was performed at 5 dedicated study sites with identical setup across Germany. Liver fat (proton density fat fraction, PDFF), R2* as proxy for liver iron, and liver volume were assessed. The resulting data of N = 29’842 individuals (age range 20-72 years) were weighted by survey weights for regional representativeness, resulting in a sample of 50% women and a mean age of 45.6 years. SLD was defined as PDFF ≥ 5.75%, and sex-specific prevalence according to age, BMI, socioeconomic status and geographic region was calculated. RESULTS: Overall, SLD prevalence was 21.3% in women and 35.7% in men, and the majority were metabolic dysfunction-associated (MASLD, 89.3% of all SLD cases). Prevalence increased with age in a sex-specific pattern, suggesting potential menopausal effects in women. There was a relevant prevalence of SLD in individuals with normal weight (5.3% in women, 13.2% in men) and the age group <25 years (7.5% in women, 11.9% in women). Differences in prevalence between low and high socioeconomic status were more pronounced in women (37% vs 15.8%) compared to men (45.5% vs 30.3%). CONCLUSIONS: Data underscore the high public health relevance of SLD and its subcategory MASLD. The considerable prevalence in groups historically considered low-risk, such as younger or lean individuals, emphasizes the need for raising awareness early. |
| Keywords: | SLD, MASLD, Magnetic Resonance Imaging, Population-Based, Public Health |
| Source: | medRxiv |
| Publisher: | Cold Spring Harbor Laboratory Press |
| Article Number: | 2026.05.29.26354407 |
| Date: | 1 June 2026 |
| Official Publication: | https://doi.org/10.64898/2026.05.29.26354407 |
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