# Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease Among Overweight and Obese Patients With Type 2 Diabetes Mellitus

## TL;DR

This study finds that over a third of overweight and obese type 2 diabetes patients in India have fatty liver disease, linked to obesity and poor blood sugar control.

## Contribution

The study reports the prevalence of MASLD in T2DM patients in an Indian urban hospital and identifies key metabolic predictors.

## Key findings

- MASLD prevalence was 34% among T2DM patients in Howrah, India.
- MASLD was strongly associated with higher BMI, poor glycemic control, elevated liver enzymes, and hypercholesterolemia.
- Obesity (BMI ≥30), HbA1c ≥7.5%, and hypercholesterolemia were independent predictors of MASLD.

## Abstract

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD), earlier known as non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease globally, strongly associated with type 2 diabetes mellitus (T2DM) and metabolic syndrome. Its prevalence in India is increasing due to urbanization, sedentary lifestyles, and dietary changes. NAFLD/MASLD is common among individuals with T2DM, yet it often remains underdiagnosed in resource-limited settings. This study aimed to estimate the prevalence of MASLD among T2DM patients in an urban district hospital in Howrah, India, and assess its association with demographic, anthropometric, glycemic, lipid, and liver enzyme profiles.

Methods

This cross-sectional observational study was conducted in the Department of General Medicine, District Hospital, Howrah, from November 2018 to October 2019. A total of 150 purposively sampled adults (20-75 years) with T2DM (per ADA 2017 criteria) and BMI ≥25 kg/m² were enrolled after excluding significant alcohol use, viral hepatitis, chronic liver disease, HIV, and hepatotoxic drug use. Data collected included demographics, BMI, lifestyle factors, fasting blood sugar (FBS), postprandial blood sugar (PPBS), HbA1c, lipid profile, and liver function tests. Abdominal ultrasonography, performed by a single blinded radiologist, was used to diagnose MASLD based on standard echogenic criteria. Statistical analysis included independent t-tests, Chi-square tests, and multivariate logistic regression to identify predictors of MASLD, with p<0.05 considered significant.

Results

Of 150 T2DM patients (mean age: 54.3 ± 10.2 years; 41.3% male), MASLD prevalence was 34% (n=51). MASLD patients had significantly higher BMI (29.10 ± 3.12 vs. 26.96 ± 2.87 kg/m²; p < 0.001) and obesity rates (33.3% vs. 7.1%). Poor glycemic control was more common in MASLD: elevated FBS (≥140 mg/dL) in 60.8% vs. 26.3%, PPBS (≥200 mg/dL) in 76.5% vs. 40.4%, and HbA1c ≥7.5% in 47.1% vs. 23.4% (all p < 0.01). Elevated ALT (≥45 IU/L) occurred in 17.6% vs. 6.1% (p = 0.035) and AST (≥45 IU/L) in 51% vs. 19.2% (p < 0.001). Hypercholesterolemia (≥200 mg/dL) was more frequent in MASLD (47.1% vs. 14.1%, p < 0.001), whereas low HDL was prevalent in both groups. Logistic regression identified BMI ≥30 kg/m² (aOR 4.29; 95% CI 1.88-9.78), poor glycemic control (HbA1c ≥7.5%; aOR 2.67; 95% CI 1.21-5.89), and hypercholesterolemia (aOR 3.41; 95% CI 1.54-7.54) as independent predictors.

Conclusions

MASLD affects over one-third of urban T2DM patients in this Eastern Indian cohort, with strong associations to obesity, poor glycemic control, elevated liver enzymes, and hypercholesterolemia. Given its asymptomatic course and potential progression to cirrhosis and cardiovascular disease, routine MASLD screening in diabetic care is warranted. Early lifestyle and metabolic interventions could reduce long-term morbidity.