Non-lean versus lean MASLD: associations with advanced cardiovascular-kidney-metabolic syndrome in adults with type 2 diabetes mellitus, a cross-sectional study.

摘要

INTRODUCTION: This study seeks to explore the impact of lean and non-lean phenotypes of metabolic dysfunction-associated steatotic liver disease (MASLD) on the prevalence of advanced cardiovascular-kidney-metabolic (CKM) syndrome stage in individuals with type 2 diabetes mellitus (T2DM). METHODS: Based on a BMI cutoff of 23 kg/m², 705 hospitalized patients with T2DM and MASLD were split into lean and non-lean categories. Data on clinical characteristics, fat distribution, liver and kidney function, and metabolic markers were collected. The relationship between MASLD phenotypes and concurrent CKM staging severity was evaluated using multivariate logistic regression. RESULTS: In patients with T2DM and MASLD, 26.7% had lean MASLD. When accounting for age, gender, and diabetes duration, the non-lean MASLD group had higher rates of cardiovascular events (21.3% compared to 10.1%), cerebrovascular events (18.0% compared to 12.2%), and CKM stage 4 (33.5% compared to 18.6%) than the lean group (all P < 0.05). There was no notable difference in the prevalence of CKM stage 3 (61.9% vs. 56.9%, P = 0.148). Binary logistic regression analysis indicated that non-lean MASLD was independently associated with a higher prevalence of advanced stage of CKM, in comparison to lean MASLD (OR = 2.674, P < 0.001). Higher levels of visceral fat area, insulin resistance, and C-peptide were observed in the non-lean group (all P < 0.05), with liver fibrosis indices remaining similar. CONCLUSION: In patients with T2DM and MASLD, non-lean MASLD exhibits an independent positive correlation with severe CKM syndrome when compared to lean MASLD.