Can combined adiposity and systemic inflammation better identify patients with type 2 diabetes mellitus (T2DM) at risk of metabolic dysfunction-associated steatotic liver disease (MASLD)? A prospective cohort analysis published in Metabolic Syndrome and Related Disorders evaluated this question over long-term follow-up.

This study included 2,796 adults with T2DM without MASLD at baseline and followed them for 14 years. Participants were categorized based on body mass index (BMI) (<24 vs ≥24 kg/m²) and high-sensitivity C-reactive protein (hsCRP) (<3 vs ≥3 mg/L). The analysis used multivariable Cox proportional hazards models to estimate the risk of incident MASLD, defined by ultrasonographic steatosis.

During follow-up, MASLD developed in 53.9% of participants. Both higher BMI and elevated hsCRP showed independent associations with MASLD incidence. In joint analysis, individuals with both elevated BMI and hsCRP had the highest risk compared with those with low levels of both markers (adjusted hazard ratio [HR] 2.31; 95% confidence interval [CI] 1.94-2.74). This combined risk exceeded that observed with isolated high BMI (HR 1.93) or elevated hsCRP alone (HR 1.37).

These findings suggest that concurrent assessment of adiposity and systemic inflammation may improve risk stratification for MASLD in individuals with T2DM, supporting more targeted identification of higher-risk populations.