SRINAGAR: Nearly two-thirds of patients newly diagnosed with Type 2 diabetes mellitus (T2DM) were found to have metabolic dysfunction-associated steatotic liver disease (MASLD), with the condition affecting women more frequently than men, according to a study by a team of doctors from Kashmir.
The study found MASLD in 64 per cent of 272 patients examined, while higher body mass index (BMI), waist-to-hip ratio, elevated liver enzymes and triglycerides were among the factors associated with the disease and, in several cases, its severity.
The research, Prevalence, Clinical Profile and Risk Factors of Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) in Newly Diagnosed Type 2 Diabetes Mellitus, was authored by Hilal Bhat of the Department of Medicine, Government Medical College (GMC), Srinagar; Rayees ul Hamid Wani, Suhail Jabbar Mir and Javaid Ahmad Bhat of the Department of Medicine, GMC Handwara; Moomin Hussain Bhat of the Department of Endocrinology, Superspeciality Hospital, GMC Srinagar; and Shariq Rashid Masoodi of the Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar.
The original research paper was published on September 30, 2026 (Volume 33, Issue 3) of the Romanian Journal of Diabetes, Nutrition and Metabolic Diseases.
High Prevalence
The researchers studied 272 adults who had been diagnosed with Type 2 diabetes within the preceding six months. Of them, 146 were men and 126 women. Ultrasonography detected some grade of hepatic steatosis in 174 patients, placing them in the MASLD group, while 98 had no evidence of MASLD.
Overall prevalence was 64 per cent. The rate was substantially higher among women, at 71.4 per cent, compared with 57.5 per cent among men.
The researchers said the findings demonstrate a “substantial burden” of MASLD even among patients who had only recently been diagnosed with diabetes.
MASLD refers to the accumulation of fat in the liver in association with metabolic dysfunction. The researchers noted that it can remain asymptomatic and, if it progresses, may be associated with more serious conditions including metabolic dysfunction-associated steatohepatitis, liver fibrosis, cirrhosis and hepatocellular carcinoma.
Obesity Link
The study found clear associations between measures of body fat and MASLD. Patients with MASLD had a higher average BMI than those without it, at 26.96 compared with 26.32 kg/m². Their average waist-to-hip ratio was also higher, at 0.99 compared with 0.96.
The relationship became more pronounced with increasing severity of fatty liver. Median BMI rose from 25.2 kg/m² among patients with Grade I disease to 26.2 kg/m² among those with Grade II disease. Median waist-to-hip ratio similarly increased from 0.97 to 1.01.
The researchers said these findings suggest that increasing overall and central adiposity is associated not merely with the presence of MASLD but also with greater severity of hepatic steatosis.
Metabolic Markers
Patients with MASLD also recorded higher levels of several biochemical markers.
Their mean aspartate aminotransferase (AST) was 41.18 U/L compared with 31.59 U/L among those without MASLD, while alanine aminotransferase (ALT) was 59.48 U/L compared with 42.40 U/L.
Serum uric acid, fasting plasma glucose, fasting insulin and triglycerides were also higher in the MASLD group. Mean triglycerides were 220 mg/dl among patients with MASLD compared with 192 mg/dl among those without it.
Conversely, high-density lipoprotein cholesterol (HDL-C), often referred to as “good” cholesterol, was lower in the MASLD group—32 mg/dl compared with 39 mg/dl.
The researchers found that serum uric acid also increased substantially with the grade of fatty liver, with median levels of 4.6 mg/dl in Grade I disease and 6.6 mg/dl in Grade II, compared with 4 mg/dl among patients without MASLD.
Independent Factors
Multiple linear regression analysis identified BMI, waist-to-hip ratio, ALT, triglycerides and HDL as independently associated with MASLD.
The study found positive associations for BMI, waist-to-hip ratio, ALT and triglycerides, while HDL showed an inverse association.
The researchers concluded that obesity was a major metabolic risk factor and that BMI and waist-related measurements were associated with both the presence and severity of MASLD.
Study Design
The study was based on patients attending the endocrinology outpatient department of SKIMS, a tertiary-care endocrinology centre, between June 2020 and July 2023.
Patients aged 18 years or older who had been diagnosed with Type 2 diabetes within the previous six months were included. Those with Type 1 diabetes, a history of alcoholism, pregnancy, known liver disease, kidney disease, endocrinopathies, genetic disorders or use of medicines known to cause fatty liver were excluded.
MASLD was diagnosed using imaging evidence of hepatic steatosis along with at least one cardiometabolic risk factor. The liver assessment was performed through B-mode ultrasonography by a single experienced senior radiologist.
The researchers classified fatty liver into three grades on ultrasound. Grade I indicated increased hepatic echogenicity with visible periportal and diaphragmatic echogenicity; Grade II involved increased echogenicity with imperceptible periportal echogenicity but without obscuration of the diaphragm; and Grade III involved obscuration of the diaphragm as well.
Clinical Significance
The researchers said the association between diabetes and MASLD appears to be bidirectional, with metabolic dysfunction, obesity and insulin resistance potentially contributing to both conditions.
They also noted that South Asians can have relatively high metabolic risk despite not necessarily appearing overtly obese, with body composition characterised by greater adiposity and lower muscle mass potentially increasing susceptibility to metabolic disorders.
The study therefore argues for greater attention to liver health when patients are diagnosed with Type 2 diabetes.
“The significant prevalence of MASLD in newly diagnosed T2DM patients in this study underscores the importance of incorporating routine screening in diabetic care,” the authors wrote, saying early detection could help reduce the burden of liver-related complications.
Study Limits
The researchers cautioned that the findings should be interpreted in light of several limitations. Because the study was cross-sectional, it could establish associations but could not demonstrate causation or determine whether the identified factors caused disease progression.
They also acknowledged that ultrasound sensitivity varies according to the degree of hepatic steatosis and that the study did not use liver biopsy or advanced imaging techniques. Besides, the single-centre design and ethnically homogeneous study population could limit the generalisability of the findings to other populations and healthcare settings.
The authors concluded that patients diagnosed with Type 2 diabetes should undergo thorough clinical assessment for early detection and management of hepatic impairment, particularly in the presence of obesity and other metabolic risk factors.
