Body composition rather than liver fat associates with carotid Intima-Media thickness in youth with type 1 diabetes

IntroductionMetabolic dysfunction-associated steatotic liver disease (MASLD) is a recognized cardiometabolic risk factor in adults, but its relevance to early vascular remodeling in youth with type 1 diabetes (T1D) remains unclear. We evaluated the independent associations of hepatic fat and body composition with early structural vascular remodeling in youth with T1D.MethodsThis cross-sectional study included 49 late-pubertal youth with T1D (mean age 16.1±2.6 years; duration 7.5±4.3 years). Hepatic fat was quantified using MRI-proton density fat fraction (PDFF), while body composition and estimated insulin sensitivity (eIS) were assessed using dual-energy X-ray absorptiometry and a validated pediatric equation. Carotid intima-media thickness (cIMT), measured by ultrasound, served as the primary outcome. Hierarchical linear regression assessed independent associations after adjustment for age, sex, and diabetes duration.ResultsMean hepatic fat was 1.87±1.22%, with no participants meeting criteria for steatosis. Hepatic fat, eIS, and diabetes duration were not associated with cIMT. Lean body mass was the primary independent associate of cIMT (β=0.44, p=0.02). Although eIS was strongly associated with waist circumference (r=-0.76, p<0.001), neither variable was associated with cIMT.ConclusionsIn this sub-steatotic cohort, cIMT was primarily associated with lean body mass, reflecting physiologic growth, while central adiposity was associated with metabolic dysfunction but not vascular structure.