Applying 1-hour postload plasma glucose diagnostic criteria reveals high Progressive Risks of potential MASLD

Recently, a 1-h PG value of ≥ 8.6 mmol/L, a more sensitive predictor of diabetes mellitus-related long-term cardiovascular complications than routine glucose markers, has been recommended as an additional diagnostic criterion for diabetes in the International Diabetes Federation Position Statement. However, its value in MASLD remains uncertain.

Consecutive participants with imaging assessments of fatty liver and a 75-g oral glucose tolerance test, including 1154 participants with MASLD, 161 fulfilling the nonalcoholic fatty liver disease but not the MASLD diagnostic criteria (NAFLD-non-MASLD) and 1026 subjects with non-fatty liver, were retrospectively enrolled from June 2009 to May 2024.

Patients with MASLD or NAFLD-non-MASLD had higher 1-h PG levels than those with non-fatty liver (p < 0.001). In patients with MASLD or NAFLD-non-MASLD, 1-h PG ≥ 8.6 mmol/L was associated with the risk of moderate-to-severe steatosis (p < 0.001), ALT elevation (p < 0.001), advanced fibrosis (p = 0.03), and cardiovascular diseases (p < 0.001). Furthermore, NAFLD-non-MASLD patients with 1-h PG ≥ 8.6 mmol/L showed a higher prevalence of advanced fibrosis than MASLD patients with or without 1-h PG ≥ 8.6 mmol/L (p < 0.05).

NAFLD-non-MASLD patients with 1-h PG ≥ 8.6 mmol/L are still at high risk of poor clinical outcomes. These findings support including 1-h PG ≥ 8.6 mmol/L as a component of the metabolic dysfunction definition.