Association between Zhejiang University index and metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus

doi:10.4239/wjd.v16.i10.110406

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World Journal of Diabetes

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1948-9358

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

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World J Diabetes. Oct 15, 2025; 16(10): 110406
Published online Oct 15, 2025. doi: 10.4239/wjd.v16.i10.110406

Association between Zhejiang University index and metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus

Xiao-Yan Tao, Tian-Rong Pan, Xing Zhong, Xiao-Yu Pan

Xiao-Yan Tao, Tian-Rong Pan, Xing Zhong, Xiao-Yu Pan, Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China

Xiao-Yan Tao, Tian-Rong Pan, Xing Zhong, Xiao-Yu Pan, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China

Author contributions: Pan XY and Tao XY designed the research, performed data curation, formal analysis, and methodology development, managed resources, utilized software, as well as wrote the original draft of the manuscript; Pan TR and Zhong X reviewed and edited the manuscript to ensure its scientific rigor and clarity, contributing critical input in refining the final draft. All authors approved the final version to publish.

Supported by Health Research Program of Anhui, No. AHWJ2023BAc10010; Clinical and Translational Research Project of Anhui Province, No. 202427b10020078.

Institutional review board statement: This study was approved by the Ethics Committee of the Second Affiliated Hospital of Anhui Medical University, No. YX2023-068.

Informed consent statement: Written informed consent for publication was obtained from all patients and/or their families included in this study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

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 sets generated and analyzed during this study are not public, but under reasonable requirements, the correspondence author can provide.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Xiao-Yu Pan, Department of Endocrinology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei 230601, Anhui Province, China. pxy20201@outlook.com

Received: June 5, 2025
Revised: June 24, 2025
Accepted: September 12, 2025
Published online: October 15, 2025
Processing time: 131 Days and 21.5 Hours

Abstract

BACKGROUND

The Zhejiang University (ZJU) index has been demonstrated to have notable value in predicting metabolic dysfunction-associated steatotic liver disease (MASLD) within Chinese populations. However, the correlation between the ZJU index and MASLD in type 2 diabetes mellitus (T2DM) patients remains to be elucidated.

AIM

To investigate the association between the ZJU index and MASLD among patients with T2DM.

METHODS

This cross-sectional study was conducted on hospitalised patients diagnosed with T2DM. Anthropometric measurements, laboratory data, and ultrasound results were initially collected from all patients. The ZJU index was subsequently calculated. Regression analysis was then used to explore risk factors affecting MASLD, and the optimal ZJU index cut-off value for diagnosing MASLD was determined using restricted cubic spline analysis. Finally, a new model for predicting MASLD in T2DM patients based on the ZJU index was constructed. This model was based on the risk factors identified by regression analysis, and the area under curve values were calculated. The validity and reliability of the models were then compared with each other.

RESULTS

A total of 688 patients with T2DM were included in this study. A significant positive correlation was identified between the ZJU index and the development of MASLD. Furthermore, the results of the restricted cubic spline analysis showed a non-linear association between ZJU index and MASLD. The ZJU value of 38.87 was identified as the key threshold for diagnosing MASLD. The new predictive model, which was developed by regression analysis, demonstrated a higher diagnostic value for MASLD and exhibited good accuracy in comparison with metabolic indices alone (area under curve = 0.76, 95% confidence interval: 0.72-0.80).

CONCLUSION

The ZJU index has been shown to be linked to the risk of developing MASLD, and the new model constructed has been shown to possess good predictive value.

Keywords: Body mass index; Insulin resistance; Metabolic dysfunction-associated steatotic liver disease; Type 2 diabetes mellitus; Zhejiang University index

Core Tip: This study is pioneering in its systematic evaluation of the correlation between the Zhejiang University (ZJU) index and metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM), and the construction of a new model for predicting MASLD. This study demonstrated that an elevated ZJU index was associated with an increased risk of MASLD in patients with T2DM. The risk of MASLD increased significantly when the ZJU index exceeded 38.87. The novel model developed has been shown to have a satisfactory predictive value for the risk of developing MASLD in patients with T2DM.