# Association between metabolic dysfunction-associated fatty liver disease and cardiovascular autonomic neuropathy in type 2 diabetes

## TL;DR

This study shows that people with type 2 diabetes and fatty liver disease are more likely to have nerve damage affecting heart function, and this risk increases if they also have liver fibrosis.

## Contribution

The study demonstrates that MAFLD independently increases DCAN risk in T2DM patients, with fibrosis further amplifying this risk.

## Key findings

- 30.52% of T2DM patients had DCAN, with MAFLD patients showing a significantly higher prevalence (36.49% vs. 21.78%).
- MAFLD remained significantly associated with DCAN after adjusting for multiple factors (adjusted OR = 2.76).
- High FIB-4 index in MAFLD patients further increased DCAN risk (adjusted OR = 2.81).

## Abstract

This cross-sectional study aimed to elucidate the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and diabetic cardiovascular autonomic neuropathy (DCAN) in patients with type 2 diabetes mellitus (T2DM).

The study involved patients with T2DM. DCAN was diagnosed using standardized cardiovascular autonomic reflex tests (CARTs) with a total score≥2. MAFLD was defined by the presence of fatty liver disease and T2DM, excluding other liver diseases. The fibrosis-4 (FIB-4) >1.3 indicated a potential risk of fibrosis based on prior studies.

Overall, 30.52% (76/249) patients had DCAN. Patients with MAFLD had a significantly higher prevalence of DCAN than those without (36.49% vs. 21.78%, P=0.013). Univariable analysis revealed a significant association between MAFLD and DCAN (OR = 2.06, 95% CI: 1.16-3.68, P=0.014). This association remained significant even after multivariable adjustment for demographics, diabetes duration, comorbidities (hypertension, diabetic peripheral neuropathy, diabetic retinopathy, metabolic syndrome), and renal function (adjusted OR = 2.76, 95% CI: 1.44-5.29, P=0.002). Among T2DM patients with MAFLD, a high FIB-4 index (>1.3) was independently associated with a substantially increased DCAN risk (adjusted OR = 2.81, 95% CI: 1.19-6.63, P=0.018).

MAFLD is independently associated with a higher prevalence of DCAN in patients with T2DM. The risk was further amplified when high FIB-4 index (FIB-4 >1.3) was present among those with MAFLD. Hence, screening for MAFLD and its associated high FIB-4 levels may help identify patients with T2DM at a higher risk of DCAN.