Association between visceral adiposity index and metabolic dysfunction-associated steatotic liver disease in adults with type 1 diabetes mellitus: an exploratory cross-sectional study.

PURPOSE: The visceral adiposity index (VAI), a sex-specific surrogate marker of visceral adipose tissue dysfunction and insulin resistance, has been proposed to identify metabolic dysfunction-associated steatotic liver disease (MASLD) in both the general population and individuals with type 2 diabetes. However, its association with MASLD in adults with type 1 diabetes mellitus (T1DM) remains unknown. METHODS: We consecutively enrolled 212 adults with T1DM who underwent vibration-controlled transient elastography for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) assessment. MASLD was defined as CAP ≥ 248 dB/m with at least one cardiometabolic risk factor. VAI was calculated using sex-specific formulas that included waist circumference, body mass index, triglycerides, and high-density lipoprotein cholesterol. RESULTS: MASLD was present in 62 (29.3%) participants, and significant fibrosis (LSM ≥ 8 kPa) was detected in 9 (4.3%) participants. Higher VAI values were significantly associated with MASLD (unadjusted odds ratio [OR] 1.87, 95% confidence interval [CI] 1.36-2.58; p < 0.001). This association remained significant after adjustment for study center, age, diabetes duration, hemoglobin A1c, and hypertension (adjusted OR 1.84, 95%CI 1.27-2.66; p = 0.001). However, waist circumference demonstrated better discriminatory performance in identifying MASLD than VAI (AUC 0.834, 95%CI 0.772-0.896 vs. AUC 0.708, 95%CI 0.631-0.785; p = 0.006 by DeLong test), whereas BMI showed comparable discriminatory performance. CONCLUSIONS: Higher VAI values are associated with MASLD in patients with T1DM. However, waist circumference outperforms VAI in identifying MASLD, suggesting that VAI may serve as a complementary marker of metabolic dysfunction rather than a standalone screening tool for MASLD in this patient population.