Association of temporal MASLD with type 2 diabetes, cardiovascular disease and mortality
Authors' conclusion
Persistent MASLD is associated with an increased risk of incident T2DM, and further elevates the risk of CVD, and mortality among individuals with T2DM. Even individuals with incident or regressed MASLD exhibit an increased risk of these adverse outcomes compared to those who never had MASLD.
Study context
- Population
- Individuals aged ≥ 20 years, Korean National Health Insurance Service; MASLD defined as fatty liver index (FLI) ≥ 60, compared between two health checkups 2 years apartwithout T2D
- Participants
- 4,397,808 individuals
- Exposure
- Changes in MASLD status (by FLI ≥60) over 2 years: incident, regressed, persistent vs never MASLD
- Outcome
- T2D occurrence in the general population; MI, ischemic stroke, HF and mortality in individuals with preexisting T2D
Methodological detailsKorean National Health Insurance Service data, adjusted for age, sex, smoking, alcohol drinking and regular exercise
- Korean National Health Insurance Service data
- Adjusted for age, sex, smoking, alcohol drinking and regular exercise
Main finding
As reported in the abstract
Incident T2D (individuals without T2D) · median follow-up 7.3 years
Each group vs never MASLDHazard ratio (95% CI)
Persistent MASLD
5.28(5.22–5.34)
Incident MASLD
3.30(3.25–3.35)
Regressed MASLD
2.87(2.82–2.92)
- Developed T2D
- 229,475 (5.2%)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| HF, MI, stroke and all-cause mortality in individuals with preexisting T2D (n = 636,520) · median 6.2 yearsPersistent MASLDvs Never MASLD | HR (HF) 1.28 (95% CI 1.25–1.32) | |
| HF, MI, stroke and all-cause mortality in individuals with preexisting T2D (n = 636,520) · median 6.2 yearsPersistent MASLDvs Never MASLD | HR (MI) 1.15 (95% CI 1.10–1.20) | |
| HF, MI, stroke and all-cause mortality in individuals with preexisting T2D (n = 636,520) · median 6.2 yearsPersistent MASLDvs Never MASLD | HR (stroke) 1.14 (95% CI 1.09–1.19) | |
| HF, MI, stroke and all-cause mortality in individuals with preexisting T2D (n = 636,520) · median 6.2 yearsPersistent MASLDvs Never MASLD | HR (all-cause mortality) 1.11 (95% CI 1.09–1.14) | |
| 0.512Ratio (log scale) |
Heart failure (HF), myocardial infarction (MI), stroke and all-cause mortality in individuals with preexisting T2D (n = 636,520) · median 6.2 years
- Both incident and regressed MASLD were associated with an increased risk for HF, MI, stroke and all-cause mortality
Original publication
Association of temporal MASLD with type 2 diabetes, cardiovascular disease and mortality. Cardiovasc Diabetol. Published 15 July 2025. doi:10.
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