A RECENT primary care-based study has revealed that advanced liver disease is relatively uncommon in individuals with type 2 diabetes mellitus (T2DM), particularly among those without obesity. The research focused on the prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD), the most common chronic liver disease globally, often linked to obesity and T2DM.
Among 308 participants with T2DM, 59% were found to have MASLD, highlighting its strong association with metabolic risk factors such as obesity and insulin resistance. However, only 7% had suspected advanced fibrosis, and confirmed cirrhosis was present in just 1.9%. Notably, the risk of advanced fibrosis increased to 13% in those with obesity (BMI ≥ 30), while it was only 2% among normal-weight or overweight participants.
The study used magnetic resonance imaging (MRI) and vibration-controlled transient elastography (VCTE) to assess liver health, providing a detailed view of hepatic fat accumulation and fibrosis. Obesity and elevated AST levels emerged as independent predictors of advanced fibrosis, reinforcing the importance of targeted screening in high-risk groups.
Participants with MASLD showed higher levels of ectopic fat accumulation, particularly in visceral areas and skeletal muscle, though muscle volume remained unchanged. Additionally, cardiac MRI revealed structural differences in the MASLD group, including lower end-diastolic volume and higher concentricity, potentially indicating subclinical cardiovascular disease.
Importantly, the diagnostic performance of common fibrosis scoring systems, such as FIB-4 and NFS, was limited in this cohort, especially for ruling in advanced fibrosis. The study’s comprehensive approach, including detailed body composition and cardiac imaging, strengthens the findings, although the researchers acknowledge limitations such as small sample size and potential volunteer bias.
Overall, the results suggest that while MASLD is common in patients with T2DM in primary care, advanced liver disease is rare, particularly in the absence of obesity. These findings support a more targeted approach to screening, focusing on obese individuals with T2DM who are at greater risk of liver fibrosis.
Reference
Balkhed W et al. Evaluating the prevalence and severity of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus in primary care. J Intern Med. 2025;DOI:10.1111/joim.20103.
