Determinants of metabolic dysfunction associated steatotic liver disease and liver fibrosis in patients with type 2 diabetes mellitus: a cross-sectional study

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Background Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called non-alcoholic fatty liver disease (NAFLD), is today the leading cause of chronic liver conditions in the context of a global epidemic of obesity and metabolic disorders. Our study aims to determine the prevalence of MASLD and advanced liver fibrosis as well as the associated factors in patients with type 2 diabetes Mellitus (T2D). Methods Cross-sectional study including 149 patients with T2D, conducted in the Endocrinology-Diabetology and Hepato-Gastroenterology departments over a period of 6 months. Screening for steatosis and liver fibrosis was carried out using FibroScan. Results The average age of the patients was 57.9 ± 11.8 years, with a female predominance (63.8%). Based on the EASL cutoffs, the MASLD ratio was 69.1% [95% CI (61.7–76.5], n = 103). Multivariable analysis identified high Body Mass Index [aOR = 1.25; 95% CI (1.13–1.38); p < 0.001] and total cholesterol [aOR = 1.69; 95% CI (1.15–2.48); p = 0.007] as independent predictors of MASLD. The median liver stiffness measurement was 5.0 kPa (IQR 4.0–6.5). Advanced fibrosis was confidently ruled out (< 8 kPa) in 82.6% ( n = 123) of patients. Advanced fibrosis could not be ruled out (≥8 kPa) in 17.4% [95% CI (11.7-24.5), n = 26], which included 13.4% ( n = 20) in the intermediate-risk zone (8–11.99 kPa) and 4% ( n = 6) at high risk of advanced fibrosis (≥12 kPa). Higher platelet distribution width (PDW) was associated with nearly a threefold increase in the odds of advanced fibrosis (aOR = 2.78; 95% CI: 1.08–7.21; p = 0.035), while increasing GGT levels were also significantly associated with advanced fibrosis (aOR = 1.12; 95% CI: 1.03–1.21; p = 0.006). Conclusion In our study, we found that 69.1% of participants met the criteria for MASLD, and advanced fibrosis could not be ruled out in 17.4% of patients, with 4% being at high risk (≥12 kPa). It is essential to identify these at-risk patients who require multidisciplinary management in order to prevent progression to cirrhosis and its complications.

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