Association of diabetes with non-alcoholic steatohepatitis has been well documented. However, it remains unclear whether there is an association between levels of glycated hemoglobin (HbA_1c) with severity of non-alcoholic fatty liver disease (NAFLD). This study was aimed to explore the relationship between levels of HbA_1c and the risk of advanced fibrosis in patients with NAFLD.

A cross-sectional study was performed on 4826 apparently healthy Chinese, who underwent a health check between January 2015 and December 2016. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. The risk of advanced fibrosis was assessed by NAFLD fibrosis Score.

Among 4826 individuals studied, 1630 were diagnosed with NAFLD. In a multivariable-adjusted model, high HbA_1c levels were associated independently with increased prevalence of NAFLD. The adjusted odds ratio [95% confidence interval (95% CI)] for NAFLD, when compared with the highest HbA_1c quartile and the lowest HbA_1c quartile, was 2.72 (2.07–3.58; P for trend < 0.001). A strong association was also observed between HbA_1c level and the risk of fibrosis in patients with NAFLD in multivariable analyses, with the extreme-quartile odds ratio of 2.69 (95% CI: 1.60–4.53; P for trend < 0.001). This association remained significant even in subjects without diabetes.

We concluded that high HbA_1c level was associated strongly and independently with increased risk of advanced fibrosis in NAFLD patients without diabetes.