Metabolic dysfunction-associated steatotic liver disease in individuals with type 2 diabetes mellitus and diabetic foot ulcers: prevalence and associated factors

Hüseyin Karaaslan; Ensar Gazi Göçer; Ferit Doğan

doi:10.1007/s40200-025-01757-8

Metabolic dysfunction-associated steatotic liver disease in individuals with type 2 diabetes mellitus and diabetic foot ulcers: prevalence and associated factors

J Diabetes Metab Disord. 2025 Oct 14;24(2):228. doi: 10.1007/s40200-025-01757-8. eCollection 2025 Dec.

Authors

Hüseyin Karaaslan^{1

2}, Ensar Gazi Göçer³, Ferit Doğan⁴

Affiliations

¹ Faculty of Medicine, Department of Endocrinology and Metabolism, Harran University, Sanliurfa, Turkey.
² Department of Endocrinology Osmanbey Campus, Harran University School of Medicine, Haliliye, Sanliurfa, 63290 Turkey.
³ Faculty of Medicine, Department of Endocrinology and Metabolism, Inonu University, Malatya, Turkey.
⁴ Faculty of Medicine, Department of Radiology, Harran University, Sanliurfa, Turkey.

PMID: 41104307
PMCID: PMC12521669 (available on 2026-10-14)
DOI: 10.1007/s40200-025-01757-8

Abstract

Purpose: Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent among individuals with overweight, obesity, and type 2 diabetes mellitus (T2DM). Diabetic foot ulcers (DFUs) represent a severe complication of T2DM, but the prevalence of MASLD in this specific population remains unexplored. This study investigated the potential influence of DFU on MASLD incidence in T2DM.

Methods: This study included 100 individuals with T2DM and DFUs. MASLD was assessed via liver ultrasound. Demographic data, laboratory results, and body mass index (BMI) were recorded. Participants were stratified into three BMI categories (≤ 25, 25-30, and ≥ 30 kg/m²) for comparative analysis.

Results: The overall MASLD frequency was 39%, with no significant difference between genders (42.3% in males vs. 35.4% in females; p = 0.480). Inividuals with MASLD exhibited significantly higher mean BMI (27.3 ± 3.4 vs. 25.6 ± 3.7 kg/m²; p < 0.001) and hyperlipemia prevalence (59 vs. 46%; p < 0.001). The distribution of BMI categories in the overall sample resulted in 40% normal weight, 44% overweight, and 16% obese of prevalence (p < 0.001). MASLD prevalence increased with BMI category: 15% (BMI ≤ 25 kg/m²), 50% (BMI 25-30 kg/m²), and 69% (BMI ≥ 30 kg/m²).

Conclusions: This study offers novel insights into MASLD prevalence among individuals with T2DM and DFU, suggesting a potential association between lower BMI and reduced MASLD incidence. However, MASLD development is multifactorial. Further research is needed to investigate the lower BMI levels observed and elucidate the complex interplay of factors influencing MASLD development in this population.

Keywords: Body mass index; Diabetic foot ulcer; Metabolic dysfunction–associated steatotic liver disease; Non-Alcoholic fatty liver disease; Type 2 diabetes mellitus.

© The Author(s), under exclusive licence to Tehran University of Medical Sciences 2025. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.