A RECENT prospective study from Türkiye has shed light on the prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in individuals with type 2 diabetes mellitus (T2DM), highlighting concerning levels of liver fibrosis in this population.
MASLD, formerly known as non-alcoholic fatty liver disease, is diagnosed when hepatic steatosis is present alongside at least one cardiometabolic risk factor, excluding harmful alcohol intake. Globally, MASLD affects around 30% of the population, but this figure rises to approximately 70% among those with T2DM.
In this study, MASLD was identified in 50% of the T2DM cohort using non-invasive methods, slightly lower than some global estimates. However, clinically significant fibrosis was found in 30.6% of patients, almost double the rate reported in earlier studies. Notably, fibrosis and cirrhosis were significantly more prevalent among obese patients. Dyslipidaemia, another metabolic syndrome component, was also associated with increased liver steatosis, while hypertension showed no significant impact on fibrosis levels.
The study also explored microvascular and macrovascular complications. A significant association was found between MASLD and diabetic nephropathy and neuropathy, though no clear link with retinopathy emerged. Interestingly, clinically significant fibrosis, rather than MASLD alone, was associated with a higher incidence of cerebrovascular events.
Serum alanine aminotransferase (ALT) levels were elevated in MASLD and fibrosis cases, but normal ALT did not rule out liver damage. This reinforces the need for improved diagnostic screening in high-risk populations like those with T2DM.
Non-invasive tools such as elastography and scoring systems (e.g., FIB-4, Agile 4, and FAST) demonstrated strong correlations with liver stiffness and steatosis measures. These methods support a tiered approach to referral decisions, potentially identifying over 40% of MASLD patients who may benefit from hepatologist evaluation.
This study contributes valuable national data, emphasising the need for heightened awareness, early diagnosis, and proactive management of MASLD in patients with T2DM in Türkiye.
Reference
İstemihan Z et al. A prospective study on the role of non-invasive tests in the evaluation of diabetes mellitus associated steatotic liver disease. Sci Rep. 2025;15(1):24397.