Correlation of hepatic steatosis and fibrosis with microvascular complications among obese and non-obese individuals with T2D and MASLD.

BACKGROUND AND OBJECTIVES: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in non-obese individuals but remains poorly studied in people with type-2 diabetes (T2D), particularly in India. The study aimed at comparing hepatic steatosis, fibrosis and diabetes-related complications between non-obese (n, 150) and obese (n, 300) individuals with T2D. METHODS: This was a comparative cross-sectional study in which the participants underwent clinical, biochemical and anthropometric assessments. Hepatic steatosis and fibrosis were evaluated using ultrasonography and transient elastography, with controlled attenuation parameter (CAP) and liver stiffness (kPa) measurements as key indicators. Diabetes-related complications were assessed using standardized protocols. RESULTS: Non-obese individuals had higher retinopathy prevalence (18%) compared to obese individuals (8%), though this difference was non-significant (p = 0.141). Peripheral neuropathy was significantly more prevalent in non-obese (50.60%) vs. obese individuals (32%, p = 0.035), even after adjusting for confounders such as smoking and duration of diabetes. While CAP and kPa values were significantly higher in obese individuals, notable proportions of non-obese participants exhibited hepatic involvement-35% had CAP > 297 dB/m and 23% had liver stiffness ≥8.2 kPa. Among non-obese individuals, liver stiffness ≥9.7 kPa was associated with higher peripheral neuropathy. The FibroScan-AST score differed significantly between groups (p < 0.001). Non-obese participants had a higher proportion of low-risk scores (78% vs. 59.2%), but 22% still showed intermediate- or high-risk. CONCLUSIONS: Although obese individuals showed quantitatively higher CAP and liver stiffness values, non-obese individuals with T2D also exhibited clinically meaningful hepatic steatosis and fibrosis. Among the diabetes-related complications, peripheral neuropathy was the only complication that was more prevalent in the non-obese group. CLINICAL TRIAL REGISTRY NUMBER: CTRI/2023/06/054199.