Associations of the insulinemic potential of diet and lifestyle with metabolic dysfunction-associated steatotic liver disease (MASLD) risk in adults with type 2 diabetes

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among individuals with type 2 diabetes mellitus (T2DM), largely due to shared metabolic risk factors such as insulin resistance and obesity. This study aimed to examine the associations between these indices and the likelihood of MASLD in adults with T2DM. In this cross-sectional study, adults with T2DM were recruited. Dietary intake and lifestyle behaviors were assessed using validated questionnaires, and insulinemic indices were calculated accordingly including the empirical dietary index for hyperinsulinemia (EDIH), the empirical dietary index for insulin resistance (EDIR), the empirical lifestyle index for hyperinsulinemia (ELIH), and the empirical lifestyle index for insulin resistance (ELIR). Lifestyle, and metabolic variables, the odds ratio for MASLD in the highest EDIR quartile was 7.81 (p = 0.001), and for ELIH it was 8 (p < 0.001), and it was 3.21 (p = 0.032) for ELIR. No significant associations were observed for EDIH. Dietary and lifestyle patterns with greater insulinemic potential may contribute to MASLD risk in individuals with T2DM. These findings highlight the importance of insulin-modulating dietary strategies in the prevention and management of liver complications in this high-risk population.