Polish Society of
Endocrinology

Introduction: The relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and overweight/obesity, as well as prediabetes or type 2 diabetes mellitus (T2DM), is complex. It is known that these conditions increase the risk of MASLD. The aim of this study was to assess the influence of body mass index (BMI), sex, and prediabetes/T2DM status on the prevalence of MASLD.

Material and methods: The study included patients from The Polish Gallstone Surgery Registry, and MASLD was diagnosed according to current criteria.

Results: Among the 3392 participants, 859 (25.3%) had normal body mass, 1302 (38.4%) were overweight, and 1231 (36.3%) had obesity. MASLD was diagnosed in 828 patients (24.4%), including 93 (11%) with normal body mass, 280 (21.4%) who were overweight, and 455 (36.9%) with obesity, p < 0.001. The odds ratios (ORs) for MASLD increased from overweight [OR = 2.30, 95% confidence interval (CI): 1.62–3.30] to obesity class I (OR = 4.50, 95% CI: 3.16–6.50), obesity class II (OR = 7.91, 95% CI: 5.11–12.33), and obesity class III (OR = 12.74, 95% CI: 7.11–22.93), with p < 0.001 for all categories. The risk of MASLD occurrence increased with BMI in obesity class III and was OR = 4.70, 95% CI: 2.08–10.64, p = 0.02 in males and OR = 5.32, 95% CI: 2.91–9.71, p < 0.001 in females. For patients without T2DM or prediabetes, the risk of MASLD in obesity class III was nearly 9-fold higher [hazard ratio (HR): 8.77, 95% CI: 5.28–14.58, p = 0.001], compared with HR = 2.85, 95% CI: 1.43–5.68, p = 0.003 for those with T2DM or prediabetes.

Conclusions: A significant association was demonstrated between the prevalence of MASLD and increasing BMI, and this relationship was more pronounced in women. T2DM/prediabetes had a predominant influence on the occurrence of MASLD. Both patients with excess body weight and, especially, patients with T2DM/prediabetes require mandatory MASLD diagnostics.