Diabetes Mellitus, Obesity, and Metabolic Dysregulation as Risk Factors for Metabolic Dysfunction-Associated Steatotic Liver Disease

Abstract

Background and Aim: New nomenclature defines metabolic dysfunction-associated steatotic liver disease (MASLD) as hepatic steatosis with at least one of the following, i.e., type 2 diabetes mellitus, obesity, and metabolic dysregulation. This study aimed to determine the risk factor profile of individual components of MASLD. Methods: Three hundred and forty-one patients attending the master health checkup between October 2022 and December 2022 at two centers were screened for fatty liver (FL) and assessed for three metabolic states: type 2 diabetes mellitus (T2DM), overweight/obesity (body mass index [BMI] ≥23 kg/m2), and metabolic dysregulation (Asia Pacific Association Study for Liver [APASL] criteria: 3 of the 5 criteria), i.e., waist circumference (WC) ≥90 cm (men); 80 cm (women); blood pressure >130/85 mm Hg, triglyceride (TGL) >150 mg/dL, high-density lipoprotein <40 mg/dL (men); <50 mg/dL (women), prediabetes (blood sugar [fasting] 100≤ to ≤125 mg/dL, or postprandial 140≤ to ≤199 mg/dL, and glycated hemoglobin 5.7≤ to ≤6.4%. Results: Of the 190 patients with FL, 172 patients had metabolic dysfunction (90.5%), 164 had raised BMI (86.3%), and 69 had diabetes (36.3%). MeS in combination with high BMI was present in 97 patients (51.1%) and all three were present in 52 (27.4%). Twenty-three patients (12.1%) had lean type MASLD, i.e., BMI <23 kg/m2. In the absence of FL (151 patients), 104 patients (54.7%) had MeS, 34 (22.5%) had T2DM, and 91 (60.3%) had raised BMI. Significant contributors to MAFLD were overweight/obese BMI ≥23 (odds ratio [OR]: 4.16), WC (men) (OR: 5.61), diabetes mellitus (OR: 1.96), and elevated S. TGL levels (OR: 4.77). Conclusion: Diagnosis of MASLD based on the presence of definite indicators of metabolic dysfunction can aid in the identification of at-risk patient groups and thereby tailor management in these patients.