Unveiling the Metabolic Nexus: Clinical Insights into MAFLD and NAFLD Prevalence and Risk Factors among Patients with Type 2 Diabetes Mellitus

Abstract

Background: Fatty liver disease has emerged as one of the most common chronic liver conditions worldwide, and its coexistence with type 2 diabetes mellitus (T2DM) has become a growing clinical concern. Traditional diagnosis of non-alcoholic fatty liver disease (NAFLD) required exclusion of significant alcohol intake, whereas the newer metabolic-associated fatty liver disease (MAFLD) framework rests on positive metabolic criteria regardless of alcohol use, a shift with real consequences for how often fatty liver is diagnosed in diabetic populations.

Objective: To determine the prevalence of MAFLD and NAFLD among patients with T2DM attending a tertiary diabetes care center in Rawalpindi and Islamabad, and to compare the clinical, biochemical, and metabolic profiles between the two diagnostic categories.

Methods: A descriptive cross-sectional study was carried out at a tertiary-care diabetes center in Islamabad, Pakistan, with data collected from December 2024 to May 2025. Sixty-four patients with T2DM were evaluated. Liver enzymes, glycemic markers, lipid profile, anthropometric measurements, and comorbidity data were extracted and analyzed. Patients were categorized according to MAFLD and NAFLD diagnostic criteria, and biomarkers were compared between diagnosis-positive and diagnosis-negative groups using one-way analysis of variance.

Results: The cohort had a mean age of 51.5 ± 11.8 years with a near-equal gender distribution; 78.1% of patients were classified as obese. Mean HbA1c was 8.5 ± 1.6%, and 88.9% met HbA1c-based criteria for T2DM. Forty-four of 64 patients (68.8%) were categorized as having either MAFLD or NAFLD. Patients positive for MAFLD or NAFLD showed significantly higher ALT, AST, BMI, HbA1c, and triglyceride levels than those negative for these conditions (p < 0.05 for most comparisons). Gastric complaints (76%), retinopathy (68%), and hypertension (46%) were the most frequently reported comorbidities.

Conclusion: MAFLD and NAFLD are both highly prevalent among patients with T2DM in this population and are strongly associated with obesity, poor glycemic control, and dyslipidemia. These findings support routine hepatic and metabolic screening in diabetic care and highlight the clinical relevance of adopting the MAFLD framework in local practice.