Correlation between Serum Zinc Level and Hepatic Fibrosis in Type 2 Diabetic Patients with Non-Alcoholic Fatty Liver Disease

Background: Zinc is an important trace element involved in metabolic regulation, insulin signaling, antioxidant and anti-inflammatory pathways. Zinc deficiency has been associated with insulin resistance (IR), oxidative stress, and liver inflammation, and non-alcoholic fatty liver disease (NAFLD) progression. This study aimed to investigate the correlation between serum zinc levels and hepatic fibrosis in type 2 diabetes mellitus (T2DM) patients with NAFLD. Patients & Methods: This cross-sectional study included 84 T2DM patients with NAFLD attended the National Nutritional Institute outpatient clinics, from June 2022 to June 2023. Participants underwent clinical, anthropometric, and biochemical assessments, including complete blood count, liver function, fasting glucose, lipid profile, fasting insulin, Homeostatic Model Assessment for Insulin Resistance, and serum zinc. NAFLD was diagnosed using the NAFLD-liver fat score and abdominal ultrasound, and hepatic fibrosis was assessed with the NAFLD fibrosis score (NFS). Results: Among the participants, 34.5% had advanced fibrosis (NFS > 0.676), and 17.9% had zinc deficiency (Zn < 80 μg/dL). Patients with advanced fibrosis were significantly older, had a higher BMI, elevated AST, and lower serum zinc levels. Serum zinc was negatively correlated with NFS (r = −0 .44, p < .001) and age, and positively with albumin. Patients with lower zinc levels showed significantly higher NFS compared to those with higher zinc levels. In multivariate analysis, age, BMI, AST, and serum zinc were independent predictors of advanced fibrosis. Conclusion: Low serum zinc levels were correlated with advanced hepatic fibrosis in T2DM patients with NAFLD, highlighting zinc’s potential as a biomarker and therapeutic target