Gastroenterology · Endocrinology · General Practice · 1 h ago
Obesity and insulin resistance mark higher fibrosis prevalence in MASLD
A real-world cross-sectional study of 1,446 adults found that MASLD and clinically significant liver fibrosis were more common with worsening glycaemia. Fibrosis was concentrated among people with obesity and higher insulin resistance, rather than increasing uniformly across glycaemic categories.
- MASLD prevalence rose across glycaemic categories.
- Fibrosis prevalence was highest with obesity and type 2 diabetes.
- Most fibrosis cases had high HOMA-IR or Adipo-IR.
- Cross-sectional findings do not establish causality.
Researchers assessed 1,446 adults attending primary care or endocrinology/diabetes clinics in a prospective, cross-sectional study. Transient elastography was used to identify steatosis and clinically significant fibrosis (stage ≥F2); suspected fibrosis was further assessed with MR-based imaging or liver biopsy. The analysis compared findings across glycaemic and BMI categories and levels of insulin resistance, measured using HOMA-IR and Adipo-IR.
MASLD prevalence was 39% among participants with normoglycaemia, 55% with prediabetes and 68% with type 2 diabetes. Clinically significant fibrosis was found in 1%, 6% and 12%, respectively. In prediabetes, fibrosis was rare among lean or overweight participants but was more prevalent in those with obesity, particularly with severe adipose tissue and systemic insulin resistance. The highest fibrosis prevalence, 16%, was in participants with both obesity and type 2 diabetes; most participants with fibrosis had HOMA-IR or Adipo-IR values in the top two quintiles.
The findings suggest that glycaemic status alone may not capture variation in fibrosis risk. The authors propose that assessing insulin resistance could help refine MASLD risk stratification in primary care. However, the cross-sectional design cannot establish causation or show that HOMA-IR-guided assessment improves outcomes; the study also does not test a screening strategy.
In practice
In adults seen in primary care or endocrinology/diabetes clinics, this study found that clinically significant fibrosis was concentrated among people with obesity and greater insulin resistance, including those with prediabetes or type 2 diabetes. The authors suggest that assessing insulin resistance, including with HOMA-IR, may help refine MASLD risk stratification. This is cross-sectional evidence and does not show that HOMA-IR-based screening improves detection or outcomes, so it does not establish a new screening approach or justify changing practice on its own.
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Diabetologia: Prediabetes and diabetes as drivers of fibrosis in MASLD: roles of obesity, adipose tissue dysfunction and insulin resistance ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.