Effects of Weight Loss on Insulin Resistance and Liver Health in T2DM and NAFLD Patients

BACKGROUND The rising comorbidity of T2DM and MASLD, driven by insulin resistance (IR), underscores the need for effective interventions. This study evaluated the impact of a 3-month structured lifestyle intervention on hepatic steatosis, IR, and metabolic parameters in patients with T2DM-MASLD. MATERIAL AND METHODS Thirty-seven patients received personalized low-calorie diets and exercise regimens. Hepatic fat was quantified via MRI-PDFF, with biochemical parameters and HOMA-IR assessed at baseline and after intervention. Participants were stratified into compliant (³5% weight loss, n=26) and non-compliant groups (<5%, n=11). RESULTS Both groups had significant reductions in BMI and hepatic fat fraction (p<0.05), with greater improvements in the compliant group. The compliant group had significant improvements in TBIL, AST, ALT, HDL-c, and HOMA-IR (a significant 31.2% reduction in HOMA-IR [p<0.001]). Multivariate analysis revealed that MRI-PDFF explained 42.5% of hepatic fat variability. CONCLUSIONS A 5% weight loss threshold effectively ameliorates hepatic steatosis and IR, reinforcing lifestyle modification as a cornerstone in T2DM-MASLD management. Integration of digital monitoring tools enhances compliance, addressing a critical barrier in real-world implementation.