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Factors associated with protection from MASLD in type 2 diabetes: A prospective study integrating longitudinal

Federica Tavaglione1, Veeral Ajmera1, Luis Antonio Díaz1,2

  • 1MASLD Research Center, Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, California, United States.

JHEP Reports : Innovation in Hepatology
|February 20, 2026
PubMed
Abstract

Insights

Individuals with type 2 diabetes can be protected from metabolic dysfunction-associated steatotic liver disease (MASLD) by maintaining a lower body mass index (BMI), improved insulin sensitivity (HOMA-IR), and lower triglycerides. Lower hepatic de novo lipogenesis may also play a protective role.

Area of Science:

  • Hepatology
  • Metabolic Diseases
  • Diabetes Research

Background:

  • Type 2 diabetes is a significant risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD).
  • Identifying protective factors against MASLD in diabetic individuals is crucial for targeted interventions.

Purpose of the Study:

  • To identify factors associated with protection from MASLD in a prospective cohort of individuals with type 2 diabetes.
  • To explore the role of hepatic de novo lipogenesis in MASLD protection.

Main Methods:

  • Prospective study of 148 individuals with type 2 diabetes.
  • Advanced liver phenotyping using MRI and MRE at baseline and 2-year follow-up.
  • Firth's penalized and regularized logistic regression for factor analysis.

Main Results:

  • Lower BMI, HOMA-IR, and triglycerides were significant predictors of protection from MASLD.
  • Exploratory analysis suggested lower hepatic de novo lipogenesis in protected individuals.

Conclusions:

  • Managing modifiable risk factors like body weight and lipid profile is key for MASLD prevention in type 2 diabetes.
  • Lower BMI, insulin resistance, and triglycerides confer protection against MASLD.
Keywords:
NAFLD/MASLDbody mass indexde novo lipogenesisinsulin resistancetriglycerides

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