Interrelationship Between Depression, Unhealthy Behavior, and Non-Alcoholic Fatty Liver Disease in the United States of America

Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease globally, with increasing prevalence among adults. Despite its growing burden, limited research has examined the influence of psychosocial factors, including unhealthy behavior on NAFLD in the USA. Retrospective cross-sectional study was conducted using data from the 2013–2018 National Health and Nutrition Examination Survey. Descriptive statistics, stratified prevalence estimates, and Poisson regression models were used to assess unadjusted and adjusted associations. The results showed that among 5804 eligible participants, the overall prevalence of NAFLD was 42%. Higher prevalence was observed among males (48%), individuals with obesity (37%), those reporting unhealthy behaviors (48%), and those with depressive disorders (47%). In adjusted models, unhealthy behavior (PR = 1.35; 95% CI: 1.22–1.49; P < 0.001) and depression (PR = 1.13; 95% CI: 1.04–1.22; P = 0.005) were independently associated with an increased prevalence of NAFLD among young US adults and is independently associated with modifiable behavioral and psychological factors. These findings underscore the need for integrated public health strategies as well as nutritional interventions that could address lifestyle behaviors and mental health to mitigate the burden of NAFLD in this population.