Zhao TJ, Xing YX, Sun NZ. Zhejiang University index - connecting type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: Clinical utility and future horizons. World J Diabetes 2026; 17(3): 115669 [DOI: 10.4239/wjd.v17.i3.115669]
Corresponding Author of This Article
Nian-Zhe Sun, MD, Department of Orthopedics, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital of Central South University, No. 87 Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, China. sunnzh201921@sina.com
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Endocrinology & Metabolism
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Letter to the Editor
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Mar 15, 2026 (publication date) through Mar 15, 2026
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World Journal of Diabetes
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1948-9358
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Zhao TJ, Xing YX, Sun NZ. Zhejiang University index - connecting type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: Clinical utility and future horizons. World J Diabetes 2026; 17(3): 115669 [DOI: 10.4239/wjd.v17.i3.115669]
World J Diabetes. Mar 15, 2026; 17(3): 115669 Published online Mar 15, 2026. doi: 10.4239/wjd.v17.i3.115669
Zhejiang University index - connecting type 2 diabetes and metabolic dysfunction-associated steatotic liver disease: Clinical utility and future horizons
Tong-Jian Zhao, Yi-Xuan Xing, Nian-Zhe Sun
Tong-Jian Zhao, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, United States
Yi-Xuan Xing, Department of Emergency, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Nian-Zhe Sun, Department of Orthopedics, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
Co-corresponding authors: Yi-Xuan Xing and Nian-Zhe Sun.
Author contributions: Zhao TJ wrote the first draft, developed the main ideas, and led revisions; Xing YX and Sun NZ provided critical feedback, improved the structure, and added key examples, and they contributed equally to this manuscript and are co-corresponding authors. All authors approval the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Nian-Zhe Sun, MD, Department of Orthopedics, National Clinical Research Center of Geriatric Disorders, Xiangya Hospital of Central South University, No. 87 Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, China. sunnzh201921@sina.com
Received: October 22, 2025 Revised: November 26, 2025 Accepted: December 19, 2025 Published online: March 15, 2026 Processing time: 141 Days and 17.2 Hours
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is now the main comorbidity of type 2 diabetes mellitus, yet often under-recognized in daily clinical practice. Although liver biopsy is still considered to be the standard method for MASLD diagnosis, it is too invasive to be widely adopted in mass screenings. Recently, the Zhejiang University index using simple anthropometric and biochemical parameters was assessed in type 2 diabetes mellitus patients and found strongly associated with both the presence and severity of MASLD. These new findings illustrate that some metabolic composite scores may help complement current diagnostic strategies. In this editorial, we contextualize them, review existing ones and contrast these results, and finally explore possible research areas or directions in clinical applications.
Core Tip: Zhejiang University index provides a convenient way to estimate metabolic dysfunction-associated steatotic liver disease risk in type 2 diabetes mellitus without resorting to imaging or biopsy, relying only on basic clinical data. This simplicity makes it suitable for settings with limited medical infrastructure. However, questions remain about its validity in varied populations and whether it can reliably anticipate future liver and heart complications.
