Salvatore Corrao, Salvatore Scibetta, Brenda Bongiorno, Carola Lopriore, Luigi Calvo, Local Outpatient Registry Investigators (LOR-i)
The shifting landscape of liver transplantation etiologies highlights the growing burden of ALD and MASH, emphasizing the need for targeted prevention strategies. Persistent racial disparities in liver transplant access and outcomes underscore systemic healthcare inequities. Addressing these disparities through equitable healthcare policies, early intervention programs, and improved transplant access is crucial to ensuring fair distribution of transplant resources and improved outcomes for all populations.
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.