Liver Fibrosis, Rather Than Fatty Liver Alone, Points to Macrovascular Risk in Type 2 Diabetes

Among people with type 2 diabetes, signs of liver fibrosis are linked to a much higher chance of macrovascular alteration, according to research published in BMC Endocrine Disorders. By contrast, fatty liver by itself does not appear to add the same risk. The results suggest that, within metabolic dysfunction-associated steatotic liver disease (MASLD), the fibrotic component is more closely tied to vascular complications than fat buildup alone.

Yijun Liu and colleagues analyzed data from the National Metabolic Management Center database. After propensity score matching, the study included 2,238 patients with type 2 diabetes. Using abdominal ultrasound and a FIB-4 index cutoff of 1.3 or higher, the team divided participants into four groups: no steatosis or fibrosis, steatosis only, fibrosis only, and both steatosis and fibrosis.

Macrovascular alteration was found at different rates across the groups: 56.2 percent, 56.5 percent, 79.0 percent, and 71.5 percent, respectively. The difference was statistically significant. In practical terms, patients with fibrosis, whether or not they also had steatosis, were much more likely to show macrovascular changes than those with neither condition.

In the fully adjusted multivariable logistic regression analysis, the fibrosis-only group had significantly higher odds of macrovascular alteration than the reference group with neither steatosis nor fibrosis. The odds ratio was 1.63, with a 95 percent confidence interval of 1.25 to 2.13. The group with both steatosis and fibrosis also had elevated odds, at 1.34, with a confidence interval of 1.02 to 1.77. The steatosis-only group, however, showed no significant relationship, with an odds ratio of 1.02, suggesting that fatty liver alone did not increase risk in this cohort.

The authors concluded that, in patients with type 2 diabetes, liver fibrosis independently predicts macrovascular alteration even after accounting for traditional cardiovascular risk factors.

Subgroup analyses suggested the association was especially strong in some patient categories. It was most pronounced among men, with an odds ratio of 2.57, in people with obesity, at 2.72, and in those who had lived with diabetes for five to ten years, where the odds ratio reached 3.24. These patterns indicate that fibrosis screening may be particularly useful in certain groups.

On the basis of the findings, the researchers recommend adding the FIB-4 index to routine cardiovascular risk assessment for patients with type 2 diabetes. They argue that this non-invasive tool could help identify high-risk individuals earlier. The study suggests that targeted fibrosis screening may be especially relevant for men, patients with obesity, and those within the five-to-ten-year period after a diabetes diagnosis, with FIB-4-based screening offering a practical and cost-effective way to support risk stratification.

The authors also note important limitations. The study shows an association, not proof that fibrosis causes macrovascular change. The FIB-4 index is a calculated, non-invasive marker rather than a biopsy-based measurement, and the findings apply to the specific matched sample of 2,238 patients with type 2 diabetes. Even so, the main takeaway remains the same: in people with type 2 diabetes and fatty liver disease, fibrosis identified through the FIB-4 index marks the group most likely to have macrovascular alteration.

Subject of Research: The relationship between metabolic dysfunction-associated steatotic liver disease phenotypes and macrovascular alteration in patients with type 2 diabetes.

Article Title: Association between MASLD and macrovascular alteration in patients with type 2 diabetes mellitus

Article References: Liu, Y., Wang, X., Li, X., Yang, J., Zhou, J., Wu, H., Lu, Y., & Li, L. (2026). Association between MASLD and macrovascular alteration in patients with type 2 diabetes mellitus. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02632-0

Image Credits: AI Generated

Keywords: MASLD, type 2 diabetes, liver fibrosis, FIB-4 index, hepatic steatosis, macrovascular alteration, cardiovascular risk, propensity score matching, cross-sectional study, risk stratification, Association, between

Cite Scienmag News

Ophelia Keating. Liver Fibrosis, Rather Than Fatty Liver Alone, Points to Macrovascular Risk in Type 2 Diabetes. Scienmag. https://scienmag.com/liver-fibrosis-not-fatty-liver-alone-signals-macrovascular-risk-in-type-2-diabetes/

Ophelia Keating. "Liver Fibrosis, Rather Than Fatty Liver Alone, Points to Macrovascular Risk in Type 2 Diabetes." Scienmag, https://scienmag.com/liver-fibrosis-not-fatty-liver-alone-signals-macrovascular-risk-in-type-2-diabetes/. Accessed 27 October 2026.