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Background <p>Metabolic dysfunction–associated steatotic liver disease (MASLD) is a hepatic manifestation of metabolic syndrome and a leading cause of chronic liver disease worldwide. Its strong association with diabetes mellitus significantly increases the risk of progressive liver fibrosis and cardiovascular complications. Early assessment using non-invasive tools is essential for timely intervention and risk stratification.</p> Objectives <p>To diagnose MASLD, assess its severity using APRI, FIB-4 score, and transient elastography (FibroScan), compare disease burden in individuals with and without diabetes, and evaluate cardiovascular risk using the triglyceride-to-HDL (TG/HDL) ratio.</p> Methods <p>A cross-sectional observational study was conducted on 122 MASLD patients at a tertiary care center. Patients were categorized into groups with and without diabetes based on established ADA criteria (HbA1c ≥ 6. %, Fasting Plasma Glucose ≥ 126&#xa0;mg/dl, or 2&#xa0;h post prandial ≥ 200&#xa0;mg/dl, or prior diagnosis of diabetes or glucose lowering treatment. Alcohol consumption was assessed using a standardized questionnaire (AUDIT-C) as per MASLD guidelines. Clinical evaluation, laboratory investigations, FibroScan assessment, and calculation of APRI, FIB-4, and TG/HDL ratio were performed. Statistical analysis was carried out using appropriate parametric and non-parametric tests (e.g., Mann-Whitney U test for non-normally distributed variables like triglycerides, assessed using Shapiro-Wilk test).</p> Results <p>Among 122 patients with MASLD, those with diabetes demonstrated significantly greater fibrosis severity, with higher FIB-4 scores, CAP values, and liver stiffness measurements compared with patients without diabetes. In multivariable logistic regression analysis, diabetes mellitus (OR 6.17, 95% CI 2.27–16.78), increasing age, obesity, HbA1c ≥ 6.5%, and TG/HDL ratio &gt; 7 were independently associated with advanced fibrosis. Patients with diabetes also had significantly higher TG/HDL ratios, indicating increased cardiovascular risk.</p> Conclusion <p>Diabetic MASLD patients exhibit more advanced hepatic fibrosis and higher cardiovascular risk compared to patient without diabetes. Non-invasive tools such as APRI, FIB-4, FibroScan, and TG/HDL ratio are effective for early risk stratification.</p>

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Assessment of Severity of Metabolic Dysfunction–Associated Steatotic Liver Disease and Cardiovascular Risk in Individuals with and without Diabetes

  • 期刊论文

  • 发表日期：

    2026年7月27日

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  • Manoj Kumar Mathur,
  • Poonam Gupta,
  • Pratham Agarwal,
  • Ajeet Kumar Chaurasia,
  • Divya Chutani

摘要

Background

Metabolic dysfunction–associated steatotic liver disease (MASLD) is a hepatic manifestation of metabolic syndrome and a leading cause of chronic liver disease worldwide. Its strong association with diabetes mellitus significantly increases the risk of progressive liver fibrosis and cardiovascular complications. Early assessment using non-invasive tools is essential for timely intervention and risk stratification.

Objectives

To diagnose MASLD, assess its severity using APRI, FIB-4 score, and transient elastography (FibroScan), compare disease burden in individuals with and without diabetes, and evaluate cardiovascular risk using the triglyceride-to-HDL (TG/HDL) ratio.

Methods

A cross-sectional observational study was conducted on 122 MASLD patients at a tertiary care center. Patients were categorized into groups with and without diabetes based on established ADA criteria (HbA1c ≥ 6. %, Fasting Plasma Glucose ≥ 126 mg/dl, or 2 h post prandial ≥ 200 mg/dl, or prior diagnosis of diabetes or glucose lowering treatment. Alcohol consumption was assessed using a standardized questionnaire (AUDIT-C) as per MASLD guidelines. Clinical evaluation, laboratory investigations, FibroScan assessment, and calculation of APRI, FIB-4, and TG/HDL ratio were performed. Statistical analysis was carried out using appropriate parametric and non-parametric tests (e.g., Mann-Whitney U test for non-normally distributed variables like triglycerides, assessed using Shapiro-Wilk test).

Results

Among 122 patients with MASLD, those with diabetes demonstrated significantly greater fibrosis severity, with higher FIB-4 scores, CAP values, and liver stiffness measurements compared with patients without diabetes. In multivariable logistic regression analysis, diabetes mellitus (OR 6.17, 95% CI 2.27–16.78), increasing age, obesity, HbA1c ≥ 6.5%, and TG/HDL ratio > 7 were independently associated with advanced fibrosis. Patients with diabetes also had significantly higher TG/HDL ratios, indicating increased cardiovascular risk.

Conclusion

Diabetic MASLD patients exhibit more advanced hepatic fibrosis and higher cardiovascular risk compared to patient without diabetes. Non-invasive tools such as APRI, FIB-4, FibroScan, and TG/HDL ratio are effective for early risk stratification.