Acta diabetologica · 2026
MASLD in type 2 diabetes: steatosis-fibrosis burden and metabolic determinants in a real-world cohort.
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Corrao Salvatore, Scibetta Salvatore, Bongiorno Brenda, Lopriore Carola, Calvo Luigi, Local Outpatient Registry Investigators (LOR-i)
Аннотация
AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in type 2 diabetes mellitus (T2DM), but the burden of steatosis and fibrosis and their associated factors remain incompletely defined. We assessed the prevalence, severity, and factors associated with of MASLD in a real-world cohort of patients with T2DM.
METHODS: In this cross-sectional study, 219 consecutive outpatients with T2DM underwent anthropometric laboratory, ultrasonographic and shear-wave elastographic assessment. MASLD was defined by the multisociety Delphi consensus. Independent associations were evaluated using multivariable logistic regression, with waist circumference as the primary adiposity measure.
RESULTS: MASLD was diagnosed in 75.3% of participants. Severe steatosis (S3) was present in 11.9%, clinically significant fibrosis (F ≥ 2) in 7.3%, and advanced fibrosis (F ≥ 3) in 5.5%. Male sex (OR 2.49, 95% CI 1.26-4.94) and waist circumference (OR 1.04 per cm, 95% CI 1.01-1.07) were independently associated with MASLD. Severe steatosis was independently associated with male sex and waist circumference. MASLD prevalence increased across waist circumference quartiles (trend p = 0.001), while the adjusted odds plateaued in the upper half, paralleled by a higher prevalence of severe steatosis (p < 0.001), whereas fibrosis was not associated with abdominal adiposity (p = 0.65). HbA1c and diabetes duration did not differ between groups in univariable comparisons, and age was not associated with MASLD in the multivariable models.
CONCLUSIONS: MASLD is highly prevalent in T2DM and is independently associated with male sex and central adiposity. Abdominal adiposity identifies steatosis risk in a graded manner but does not discriminate fibrosis, supporting adiposity- and sex-informed hepatic phenotyping in patients with T2DM.
METHODS: In this cross-sectional study, 219 consecutive outpatients with T2DM underwent anthropometric laboratory, ultrasonographic and shear-wave elastographic assessment. MASLD was defined by the multisociety Delphi consensus. Independent associations were evaluated using multivariable logistic regression, with waist circumference as the primary adiposity measure.
RESULTS: MASLD was diagnosed in 75.3% of participants. Severe steatosis (S3) was present in 11.9%, clinically significant fibrosis (F ≥ 2) in 7.3%, and advanced fibrosis (F ≥ 3) in 5.5%. Male sex (OR 2.49, 95% CI 1.26-4.94) and waist circumference (OR 1.04 per cm, 95% CI 1.01-1.07) were independently associated with MASLD. Severe steatosis was independently associated with male sex and waist circumference. MASLD prevalence increased across waist circumference quartiles (trend p = 0.001), while the adjusted odds plateaued in the upper half, paralleled by a higher prevalence of severe steatosis (p < 0.001), whereas fibrosis was not associated with abdominal adiposity (p = 0.65). HbA1c and diabetes duration did not differ between groups in univariable comparisons, and age was not associated with MASLD in the multivariable models.
CONCLUSIONS: MASLD is highly prevalent in T2DM and is independently associated with male sex and central adiposity. Abdominal adiposity identifies steatosis risk in a graded manner but does not discriminate fibrosis, supporting adiposity- and sex-informed hepatic phenotyping in patients with T2DM.