Diabetes mellitus and hepatosteatosis: a narrative review

Abstract

Fatty liver, defined as lipid accumulation in more than 5% of hepatocytes, has become an increasingly important contributor to liver cirrhosis, particularly as viral hepatitis is being brought under control through vaccination and antiviral therapies. Abdominal obesity and insulin resistance play a central role in its pathogenesis. The global burden of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), continues to rise in parallel with the increasing prevalence of obesity and type 2 diabetes mellitus (T2DM). While meta-analyses indicate that the overall worldwide prevalence of MASLD is approximately 30%, higher rates have been reported in regions such as Latin America and North America. Among individuals with T2DM, the prevalence may reach up to 65%, and MASLD in these patients frequently progresses to metabolic dysfunction-associated steatohepatitis (MASH) and advanced fibrosis. Shared pathogenic mechanisms-most notably insulin resistance and chronic low-grade inflammation-drive disease progression, contributing to increased morbidity and mortality. The bidirectional relationship is further underscored by the observation that MASLD itself predisposes to the development of T2DM. In addition, the coexistence of MASLD and T2DM may exert a synergistic effect on cardiovascular disease (CVD) risk, and emerging evidence suggests that MASLD may represent an independent risk factor for CVD. Consequently, individuals with both MASLD and T2DM should be recognized as a particularly high-risk population requiring comprehensive monitoring of both hepatic and cardiovascular health. In this review, we aim to provide a concise overview of the etiopathogenesis, diagnostic approaches, and therapeutic strategies related to the MASLD-T2DM interface, a global health challenge that can be regarded as a pandemic of modern times.

Keywords

fatty liver / metabolic dysfunction-associated steatotic liver disease (MASLD) / type 2 diabetes mellitus (T2DM) / abdominal obesity / insulin resistance

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