Factors associated with protection from MASLD in type 2 diabetes: A prospective study integrating longitudinal MRI/MRE and stable isotope tracing

Understanding factors conferring protection from metabolic dysfunction-associated steatotic liver disease (MASLD) in individuals with type 2 diabetes represents a novel research avenue which has not been systematically explored. In this prospective cohort of 148 individuals with type 2 diabetes undergoing advanced liver phenotyping at baseline and 2-year follow-up, we identified lower BMI, lower HOMA-IR, and lower circulating triglycerides as the strongest predictors of remaining free of MASLD. Additionally, by performing an exploratory analysis in an independent cohort of 11 individuals with type 2 diabetes with tracer data, we found that lower hepatic <i>de novo</i> lipogenesis may underlie this protective phenotype. These findings suggest that managing modifiable risk factors, such as body weight and lipid profile, may be critical for preventing MASLD development and progression in individuals with type 2 diabetes.