Prevalence and risk factors for metabolic dysfunction-associated steatotic liver disease and fibrosis in recently diagnosed type 2 diabetes

doi:10.4254/wjh.123278

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 8

This Article

(3)

(4)

(0)

(39)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Supplementary Materials of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Hepatology

ISSN

1948-5182

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. Aug 27, 2026; 18(8): 123278
Published online Aug 27, 2026. doi: 10.4254/wjh.123278

Table 1 Characteristics of the study population according to presence or absence of liver steatosis, n (%)

	Total (n = 1337)	No steatosis (n = 783)	Steatosis (n = 554)	P value
Sex (female)	814 (60.9)	468 (59.8)	346 (62.5)	0.322
Age (years)	55 (49-63)	56 (49-63)	54 (48-61)	0.003
Classification according to BMI
BMI (kg/m²), median (p25-p75)	28.3 (25.4-31.5)	27.1 (24.5-30.1)	30.4 (27.2-33.3)	< 0.001
Normal	276 (21.8)	217 (29.3)	59 (11.2)	< 0.001
Overweight	510 (40.2)	325 (43.9)	185 (35.0)
Obesity class I	346 (27.3)	153 (20.7)	193 (36.6)
Obesity class II	99 (7.8)	35 (4.7)	64 (12.1)
Obesity class III	37 (2.9)	10 (1.4)	27 (5.1)
Transient elastography
kPa	4.8 (3.8-6.0)	4.5 (3.5-5.6)	5.2 (4.2-6.6)	< 0.001
CAP (dB/m)	276 (234-317)	242 (214-266)	324 (305-346)	< 0.001
FAST score	0.07 (0.03-0.18)	0.05 (0.02-0.10)	0.15 (0.06-0.29)	< 0.001
Low risk	984 (88.0)	628 (94.3)	356 (78.8)	< 0.001
Moderate risk	109 (9.7)	32 (4.8)	77 (17.0)
High risk	25 (2.2)	6 (0.9)	19 (4.2)
FAST-HbA1c	54 (4.8)	11 (1.7)	43 (9.5)	< 0.001
Biochemical parameters
Total cholesterol, mg/dL	165 (137-193)	163 (134-190)	168 (140-197)	0.036
LDL, mg/dL	98 (74-120)	96 (73-117)	100 (77-124)	0.022
HDL, mg/dL	42 (36-51)	43 (37-52)	40 (36-48)	0.000
TGC, mg/dL	139(104-194)	127 (97-177)	157 (117-224)	0.000
Creatinine, mg/dL	0.76(0.65-0.90)	0.77 (0.67-0.90)	0.73 (0.63-0.89)	0.010
ALT, U/L	23.5(17.0-34.0)	20.7 (15.7-30.3)	28.6 (19.4-41.9)	0.000
AST, U/L	20.7 (16.6-26.9)	19.4 (16.0-25.0)	22.3 (17.7-29.2)	0.000
GGT, U/L	25.9(18.4-40.4)	22.7 (17.2-33.5)	31.8 (22.2-49.2)	0.000
HbA1c, %	6.8 (6.0-8.5)	6.6 (6.0-8.4)	7.0 (6.1-8.7)	0.018

The results are expressed as median (p25-p75). Low risk (< 0.35), moderate risk (0.35-0.66), high risk ( 0.67). BMI: Body mass index; FAST: FibroScan-AST; LDL: Low-density cholesterol; HDL: High-density cholesterol; TGC: Triglycerides; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; CAP: Controlled attenuation parameter; HbA1c: Glycated hemoglobin.

Full Size Table

Table 2 Characteristics of the study population according to the risk of liver fibrosis, n (%)

	< 8 kPa (n = 1204)	8-12 kPa (n = 77)	> 12 kPa (n = 56)	P value
Sex (female)	729 (60.5)	52 (67.5)	33 (58.9)	0.455
Age (years)	55 (49-63)	56 (48.5-62)	58 (52-64)	0.167
BMI (kg/m²)	27.9 (25.2-31.0)	31.8 (28.2-36.2)	31.4 (27.8-35.0)	< 0.001^a^,^b
BMI classification
Normal	274 (22.8)	9 (11.7)	8 (14.3)	< 0.001
Overweight	510 (42.4)	20 (26)	14 (25)
Obesity	317 (26.3)	25 (32.5)	20 (35.7)
Obesity class II	78 (6.5)	16 (20.8)	8 (14.3)
Obesity class III	25 (2.1)	7 (9.1)	6 (10.7)
Transient elastography
kPa	4.6 (3.7-5.6)	9 (8.5-10.3)	16.5 (13.4-21.8)	< 0.001^a^,^b^,^c
CAP (dB/m)	273 (231-314)	303 (266-330)	298 (257 – 349)	< 0.001^a^,^b
FAST score¹	0.06 (0.03-0.14)	0.41 (0.21-0.59)	0.56 (0.41-0.77)	< 0.001^a^,^b^,^c
Low risk	947 (94)	31 (47.7)	(13)
Moderate risk	59 (5.9)	29 (44.6)	(45.7)
High risk	1 (0.1)	5 (7.7)	19 (41.3)
FAST-HbA1c	8 (0.7)	20 (26)	26 (46.4)	< 0.001
Biochemical parameters
Total cholesterol, mg/dL	166 (138-195)	161 (131-180)	152 (128-177)	0.028^b
LDL, mg/dL	98 (75-121)	101 (68-116)	91 (68-104)	0.124
HDL, mg/dL	42 (36-51)	39 (35-47)	42 (35-48)	0.085
TGC, mg/dL	140 (103-195)	122 (102-189)	135 (114-181)	0.666
Creatinine mg/dL	0.77 (0.65-0.90)	0.73 (0.62-0.84)	0.73 (0.59-0.88)	0.107
ALT, U/L	22.4 (16.5-32.4)	39.9 (26.3-65.3)	40.2 (30.4-74.1)	< 0.001^a^,^b
AST, U/L	19.7 (16.2-25.2)	30.5 (22.2-51.4)	33.5 (28.3-57.3)	< 0.001^a^,^b
GGT, U/L	24.8 (17.9-35.8)	42.3 (28.9-64.6)	85.9 (51.1-144.8)	< 0.001^a^,^b^,^c
HbA1c, %	6.7 (6-8.5)	7.1 (6.3 – 8.9)	7.2 (6.2-9.4)	0.074

¹Available in 1118 patients.

^aP < 0.05 vs group 1 and 2.

^bP < 0.05 vs group 1 and 3.

^cP < 0.05 vs group 2 and 3.

Group 1 (< 8 kPa), group 2 (8-12 kPa) and group 3 (> 12 kPa). The results are expressed as median (p25-p75). BMI: Body mass index; FAST: FibroScan-AST; LDL: Low density cholesterol; HDL: High density cholesterol; TGC: Triglycerides; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; CAP: Controlled attenuation parameter; HbA1c: Glycated hemoglobin.

Full Size Table

Table 3 Characteristics of the study population according to control of type 2 diabetes mellitus according to glycated hemoglobin values, n (%)

	≤ 7% HbA1c (n = 649)	> 7% HbA1c (n = 508)	P value
Sex (female)	420 (64.7)	271 (53.3)	< 0.001
Age (years)	56 (49-63)	54 (47-62)	0.060
BMI (kg/m²)	28.1 (25.3-31.5)	28.4 (25.4-31.5)	0.621
BMI classification
Normal	135 (21.8)	102 (21.3)	0.496
Overweight	252 (40.8)	192 (40.0)
Obesity class I	169 (27.3)	130 (27.1)
Obesity class II	51 (8.3)	39 (8.1)
Obesity class III	11 (1.8)	17 (3.5)
Transient elastography
kPa	4.6 (3.7-5.9)	4.9 (3.9-6.2)	0.015
CAP (dB/m)	271 (231-314)	282 (237-320)	0.040
FAST score	0.08 (0.03-0.17)	0.07(0.03-0.19)	0.530
Low risk	530 (87.9)	430 (88.3)	0.077
Moderate risk	64 (10.6)	41 (8.4)
High risk	9 (1.5)	16 (3.3)
Biochemical parameters
Total cholesterol, mg/dL	163 (137-186)	171 (138-200)	0.002
LDL, mg/dL	97 (75-117)	99 (75-125)	0.086
HDL, mg/dL	43 (37-51)	40 (35-49)	< 0.001
TGC, mg/dL	129 (98-175)	159 (115-233)	< 0.001
Creatinine, mg/dL	0.76 (0.66-0.90)	0.76 (0.64-0.89)	0.297
ALT, U/L	22.7 (16.7-33.5)	24.1 (17.2-34.8)	0.091
AST, U/L	20.9 (17.2-27.3)	20.0 (15.7-26.6)	0.027
GGT, U/L	23.8 (17.5-35.6)	28.9 (20.4-45.5)	< 0.001
HbA1c, %	6.1(5.7-6.5)	8.9 (7.7-10.5)	< 0.001

The results are expressed as median (p25-p75). 1157 patients had HbA1c determined at the time of elastography. BMI: Body mass index; FAST: FibroScan-AST; LDL: Low density cholesterol; HDL: High density cholesterol; TGC: Triglycerides; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; CAP: Controlled attenuation parameter; HbA1c: Glycated hemoglobin.

Full Size Table

Table 4 Logistic regression to evaluate the risk factors associated with presence of liver steatosis

Univariate	OR	95%CI	β	P value
Age (years)	0.988	0.977-0.999	-0.12	0.027
BMI class	1.890	1.665-2.146	0.637	< 0.001
Sex	0.960	0.763-1.208	-0.041	0.727
HbA1c ≥ 6.5%	1.547	1.205-1.986	0.436	< 0.001
Triglycerides (mg/dL)	1.003	1.002-1.005	0.003	< 0.001
LDL cholesterol (mg/dL)	1.004	1.000-1.007	0.004	0.034
High AST	2.304	1.542-3.442	0.835	< 0.001
High ALT	2.634	2.044-3.395	0.969	< 0.001
Multivariate
BMI class	1.763	1.522-2.042	0.567	< 0.001
Triglycerides, mg/dL	1.002	1.001-1.004	0.002	< 0.001
LDL cholesterol	1.004	1.000-1.008	0.004	0.065
HbA1c ≥ 6.5%	1.541	1.153-2.060	0.432	0.004
High ALT	2.269	1.678-3.068	0.819	< 0.001
High AST	1.246	0.776-2.002	0.220	0.362

Age was excluded due to poor model fit as indicated by the Hosmer-Lemeshow test.

BMI: Body mass index; FAST: FibroScan-AST; LDL: Low-density cholesterol; HDL: High-density cholesterol; TGC: Triglycerides; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; HbA1c: Glycated hemoglobin; OR: Odds ratio; CI: Confidence interval.

Full Size Table

Table 5 Logistic regression to evaluate the risk factors associated with presence of liver fibrosis

Univariate	OR	95%CI	β	P value
Age	1.006	0.988-1.024	0.006	0.508
BMI class	1.783	1.492-2.131	0.578	< 0.001
Sex	0.809	0.551-1.187	-0.212	0.278
HbA1c ≥ 6.5%	1.664	1.074-2.580	0.509	0.023
Steatosis (CAP)	2.995	2.060-4.355	1.097	< 0.001
Triglycerides mg/dL	1.000	0.998-1.002	0.000	0.816
LDL cholesterol	0.994	0.988-1.001	-0.006	0.073
High AST	12.925	8.121-20.572	2.559	< 0.001
High ALT	6.681	4.160-10.729	1.899	< 0.001
GGT	1.026	1.019-1.032	0.025	< 0.001
Multivariate
BMI Class	1.500	1.169-1.924	0.405	0.001
HbA1c ≥ 6.5%	1.309	0.765-2.242	0.269	0.326
Steatosis (CAP)	1.965	1.162-3.324	0.676	0.012
High AST	4.180	2.314-7.549	1.430	< 0.001
High ALT	2.193	1.184-4.061	0.785	0.013
GGT	1.021	1.013-1.028	0.020	< 0.001

Full Size Table

Citation: Ruiz-Margáin A, Fierro-Angulo OM, González-Regueiro JA, Hernández-Jiménez SC, García-Ulloa AC, Landa-Anell V, Bril F, Roman-Calleja BM, Romo-Arellano R, Pereira-García A, Chalasani N, Macías-Rodríguez RU. Prevalence and risk factors for metabolic dysfunction-associated steatotic liver disease and fibrosis in recently diagnosed type 2 diabetes. World J Hepatol 2026; 18(8): 123278
URL: https://www.wjgnet.com/1948-5182/full/v18/i8/123278.htm
DOI: https://dx.doi.org/10.4254/wjh.123278

Ruiz-Margáin A, Fierro-Angulo OM, González-Regueiro JA, Hernández-Jiménez SC, García-Ulloa AC, Landa-Anell V, Bril F, Roman-Calleja BM, Romo-Arellano R, Pereira-García A, Chalasani N, Macías-Rodríguez RU. Prevalence and risk factors for metabolic dysfunction-associated steatotic liver disease and fibrosis in recently diagnosed type 2 diabetes. World J Hepatol 2026; 18(8): 123278 [DOI: 10.4254/wjh.123278]

All content on this site: Copyright © 1993-2026 Baishideng Publishing Group Inc, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies. For all open access content, the relevant licensing terms apply.