In 1,071 adults from the Framingham Heart Study Third Generation cohort (mean age 60.2, BMI 28.2, 56% normoglycemic), higher postprandial glucose at 2 hours after a mixed meal and CGM-derived glycemic burden metrics — particularly time above 140 mg/dL — were associated with 23–36% higher odds of hepatic steatosis. CGM measures of both glycemic burden and variability (coefficient of variation) were associated with 28–59% higher odds of hepatic fibrosis, even among adults without diabetes.
This finding matters because it extends the dysglycemia–liver disease connection into the pre-diabetic and normoglycemic range, suggesting that subclinical glucose excursions — invisible to standard fasting or HbA1c tests — may be silently driving fatty liver and early scarring. For adults, this raises a practical question worth discussing with physicians: whether a blinded CGM wear and a structured meal challenge could flag liver risk years before diabetes is diagnosed. The study uses objective measures (vibration-controlled transient elastography for liver stiffness, Dexcom G6 Pro CGM) in a sizable community cohort, lending credibility. Key limitations include its cross-sectional design — causality cannot be established — and a predominantly non-Hispanic white Framingham sample limiting generalizability. Importantly, this is a preprint posted on medRxiv and has not yet been peer-reviewed, so findings should be treated as preliminary. If confirmed, routine CGM screening in metabolically at-risk adults could identify a modifiable window to prevent progression to metabolic dysfunction-associated steatotic liver disease.