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World J Hepatol. Aug 27, 2026; 18(8): 123278
Published online Aug 27, 2026. doi: 10.4254/wjh.123278
Prevalence and risk factors for metabolic dysfunction-associated steatotic liver disease and fibrosis in recently diagnosed type 2 diabetes
Astrid Ruiz-Margáin, Oscar Manuel Fierro-Angulo, José Alberto González-Regueiro, Sergio Cesar Hernández-Jiménez, Ana Cristina García-Ulloa, Victoria Landa-Anell, Fernando Bril, Berenice Montserrat Roman-Calleja, Regina Romo-Arellano, Ariana Pereira-García, Naga Chalasani, Ricardo Ulises Macías-Rodríguez
Astrid Ruiz-Margáin, Oscar Manuel Fierro-Angulo, José Alberto González-Regueiro, Berenice Montserrat Roman-Calleja, Regina Romo-Arellano, Ariana Pereira-García, Ricardo Ulises Macías-Rodríguez, Division of Hepatology and Liver Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Ciudad de México, Mexico
Astrid Ruiz-Margáin, Ricardo Ulises Macías-Rodríguez, MICTLÁN-Network (Mechanisms of Liver Injury, Cell Death and Translational Nutrition in Liver Diseases Research Network), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Ciudad de México, Mexico
Astrid Ruiz-Margáin, Ricardo Ulises Macías-Rodríguez, Liver Fibrosis and Nutrition Lab (LFN Lab), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Ciudad de México, Mexico
Sergio Cesar Hernández-Jiménez, Ana Cristina García-Ulloa, Victoria Landa-Anell, Center of Comprehensive Care for the Patient with Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Ciudad de México, Mexico
Fernando Bril, Endocrinology, Diabetes & Metabolism, University of Alabama at Birmingham, Birmingham, AL 35233, United States
Naga Chalasani, Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Co-first authors: Astrid Ruiz-Margáin and Oscar Manuel Fierro-Angulo.
Author contributions: Macías-Rodríguez RU, Ruiz-Margáin A designed the study; Macías-Rodríguez RU acquired funding; Macías-Rodríguez RU, Ruiz-Margáin A drafted the initial protocol; Macías-Rodríguez RU, Fierro-Angulo OM, González-Regueiro JA collected data; Ruiz-Margáin A performed the statistical analysis; Macías-Rodríguez RU, Fierro-Angulo OM, Ruiz-Margáin A, González-Regueiro JA, Hernández-Jiménez SC, García-Ulloa AC, Landa-Anell V, Roman-Calleja BM, Romo-Arellano R, Pereira-García A drafted and reviewed the manuscript; Bril F, Chalasani N critically reviewed the manuscript; all authors contributed to the study and approved the final version of the manuscript. Ruiz-Margáin A and Fierro-Angulo OM contributed equally to this work as co-first authors.
AI contribution statement: No AI was used in this manuscript.
Institutional review board statement: This is a cross-sectional study carried out at a tertiary hospital in Mexico City from January 2022 to January 2024. The study followed the principles outlined in the Declaration of Helsinki and was approved by the Research Ethics Committee of the institution (Ref. No. 2985).
Informed consent statement: All participants at the center of comprehensive care for the patient with diabetes clinic provided informed written consent for the evaluations included in this study.
Conflict-of-interest statement: The authors declare no conflicts of interest for this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Ricardo Ulises Macías-Rodríguez, MD, PhD, Professor, Research Assis
tant Professor, Division of Hepatology and Liver Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga 15, Col. Belisario Dominguez Secc. XVI, Mexico 14080, Ciudad de México, Mexico.
ricardo.maciasr@incmnsz.mx
Received: May 13, 2026
Revised: June 26, 2026
Accepted: July 30, 2026
Published online: August 27, 2026
Processing time: 97 Days and 9.1 Hours
BACKGROUND
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease and the leading cause of liver-related mortality. Long-standing type 2 diabetes mellitus (T2DM) is a major risk factor for liver steatosis and fibrosis; however, whether recently diagnosed T2DM carries the same risk remains unclear. Few studies have addressed this question in Hispanic populations, who are known to exhibit faster progression of liver disease.
AIM
To assess the prevalence of MASLD and liver fibrosis in patients with recent-onset T2DM and to identify associated risk factors.
METHODS
This was a cross-sectional study including individuals with T2DM diagnosed within the past 5 years and without disabling micro or macrovascular complications. Clinical, biochemical, liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and FibroScan-AST (FAST) score were evaluated.
RESULTS
One thousand one hundred and thirty-seven patients were included, 60.9% were women, median age was 55 years (inter quartile range: 49-63) and 78.2% were overweight or obese. Overall prevalence of MASLD (using the > 288 dB/m cutoff) was 41.4%, and 10% had clinically significant liver fibrosis (LSM ≥ 8 kPa). Moreover, 3% of the population had cirrhosis. Multivariate analysis showed higher body mass index (BMI), glycated hemoglobin, triglycerides and alanine aminotransferase (ALT) were independently associated with steatosis, while higher BMI, CAP, gamma-glutamyl transferase, ALT and aspartate aminotransferase were associated with fibrosis. According to the FAST score, 4.8% of patients had at-risk metabolic dysfunction-associated steatohepatitis.
CONCLUSION
There is a high burden of MASLD and clinically significant fibrosis among adults with recently diagnosed T2DM. These findings strongly support the systematic evaluation for MASLD and liver fibrosis in this population from the time of diabetes diagnosis.
Core Tip: There is scarce data specifically evaluating the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and liver fibrosis in patients with recent-onset type 2 diabetes (< 5 years since diagnosis) and without micro or macrovascular complications. The Hispanic population is regarded as high-risk for metabolic diseases, including MASLD. We found a high prevalence of MASLD, affecting 41.4% of the study population, with 10% presenting clinically significant liver fibrosis (liver stiffness measurement ≥ 8 kPa) and 3% having cirrhosis. Our findings support incorporating liver health screening into the routine evaluation of patients with type 2 diabetes mellitus from diagnosis, even in those with good glycemic control and without chronic complications.
