Metabolic dysfunction-associated steatotic liver disease in patients with prediabetes and type 2 diabetes mellitus

Aim. The aim of this study was to identify the prevalence of steatosis degrees and stages of liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) in connection with the presence of carbohydrate metabolism disorders, such as prediabetes and type 2 diabetes mellitus (DM).

Materials and methods. Retrospective database search (4101 records) was performed. Vibration-controlled transient liver elastography with controlled attenuation parameter module was used for the assessment of liver steatosis and fibrosis. Based on the presence of carbohydrate metabolism disorders, subjects with MASLD were allocated to one of the following groups: MASLD without prediabetes or DM (group 1), MASLD with prediabetes (group 2) and MASLD with DM (group 3).

Results. Proportion of patients with severe liver steatosis (S3) was lowest in the group 1 (61.9%), while no difference was found between groups 2 and 3 (74.3% vs 76.7%; p = 0.5). Moderate-to-severe liver fibrosis (stages F2–F4) was less widespread in the group 1 (24.1%); significant difference by this parameter was also revealed between groups 2 and 3 (34.0% vs 45.4%; p = 0.004). Proportion of patients with metabolic dysfunction-associated steatohepatitis was similar in groups 2 and 3 (33.9% vs 35.4%; p = 0.7), but was lower in the group 1 (26.7% vs 33.9% and 35.4%; p = 0.02 and p < 0.001, respectively).

Conclusion. Carbohydrate metabolism disorders are closely associated with progressive steatosis and liver fibrosis in patients with MASLD. No differences in the severity of liver steatosis was found between groups with prediabetes and T2DM, however, in T2DM, the prevalence of advanced/severe liver fibrosis was highest among all studied groups.