Independent and Combined Association of Overweight and Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (Masld) With 10-Year Atherosclerotic Cardiovascular Disease Risk in Patients With Type 2 Diabetes; [الارتباط المستقل والمشترك لزيادة الوزن والسمنة والمتلازمة الأيضية]



Naderi N ; Fardesharifi M ; Allahverdi D ; Poustchi H ; Yari Z
Source: Iranian Journal of Nutrition Sciences and Food Technology Published:2026

Abstract

Background and Objectives: Type 2 diabetes mellitus (T2DM), obesity, and metabolic dysfunction–associated steatotic liver disease (MASLD) are associated with an elevated risk of atherosclerotic cardiovascular disease (ASCVD). However, the independent and combined effects of obesity and MASLD on the 10-year ASCVD risk among individuals with T2DM remain poorly defined. Materials & Methods: In this cross-sectional study, 200 patients with T2DM attending the endocrinology clinic at Dr. Shariati Hospital, Tehran, were enrolled. Based on Fibroscan results, patients were classified into MASLD and non-MASLD groups. Body mass index (BMI) and 10-year ASCVD risk were calculated using the ACC/AHA Pooled Cohort Equations. Multivariate logistic regression was performed, adjusting for age, sex, and diabetes duration. Results: Overall, 66.5% of participants were diagnosed with MASLD. Compared to those without MASLD, patients with MASLD had significantly higher mean BMI (30.07 vs. 26.17; P<0.001), total and LDL cholesterol, and 10-year ASCVD risk scores (8.29% vs. 5.96%; P=0.023). In the adjusted model, both obesity (adjusted odds ratio [aOR] = 3.52; 95% CI: 1.38–8.95) and MASLD (aOR = 3.58; 95% CI: 1.71–7.49) were independently associated with high ASCVD risk (≥ 7.5%). In addition, being overweight and obese concurrent with having MASLD was associated with a 3.11-fold and 4.44-fold increase in the risk of ASCVD, respectively. Conclusion: Both MASLD and obesity independently and synergistically increase the 10-year ASCVD risk in patients with T2DM. These findings highlight the importance of concurrent identification and management of MASLD and obesity in the cardiometabolic care of diabetic patients. © 2026, National Nutrition and Food Technology Research Institute. All rights reserved.