metabolic dysfunction-associated steatotic liver disease

Alcohol intake and markers of liver health in patients with type 2 diabetes and metabolic dysfunction–associated steatotic liver disease

Simona Cernea^1,2, Danusia Onișor^3,4, Andrada Larisa Roiban^5,6

1. Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Targu Mures, Romania
3. Department ME2/Internal Medicine VII, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Gastroenterology Clinic, Mureș County Clinical Hospital, Targu Mures, Romania
5. Diabetes Compartment/Mediaș Municipal Hospital, Mediaș, Romania
6. Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0060

Objective: The study evaluated the impact of low-level alcohol intake on liver health in patients with type 2 diabetes (T2DM) and metabolic dysfunction–associated steatotic liver disease (MASLD).
Methods: In this prospective study T2DM patients with MASLD (alcohol intake <20 g/day (women) and <30 g/day (men)) underwent a comprehensive clinical and laboratory evaluation at baseline (v1) and after 12 months (v2). Alcohol consumption was assessed using the AUDIT-C questionnaire and a detailed clinical interview. Markers of liver health were measured, and liver steatosis and fibrosis were evaluated with non-invasive indexes, including the Liver Risk Score (LRS), an indicator of the risk of liver fibrosis and liver-related events. Results: The average alcohol intake was 0.47 [2.77] g/day. Patients with an average intake >10 g alcohol/day showed significantly higher levels of aspartate aminotransferase, gamma glutamyl transpeptidase (GGT), direct bilirubin, ferritin, and higher LRS (7.86±1.64 vs. 6.86 [1.46] vs. 6.49 [1.71]; p=0.0039) at v1 compared to those who consumed <10 g/day or were abstinent. At v2, the aminotransferases and LRS were higher in patients with an alcohol intake >10 g/day compared with the other groups. In the multivariable analyses, GGT (β=0.168;p=0.008) and male sex (β=0.417;p<0.001) were independently correlated with the average alcohol intake. Drinking more than one type of alcoholic beverage significantly increased the LRS (v1: 7.02 [1.38] vs. 6.69 [1.43], p=0.0387; v2: 6.88 [1.25] vs. 6.42 [1.24], p=0.0010).
Conclusions: In patients with T2DM and MASLD, even minimal alcohol consumption is associated with markers of liver injury and higher risk of liver-related outcomes.

The impact of the Mediterranean diet on liver steatosis and fibrosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease

Simona Cernea^1,2, Danusia Onișor^3,4, Andrada Larisa Roiban^5,6

1. Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Targu Mures, Romania
3. Department ME2/Internal Medicine VII, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania
4. Gastroenterology Clinic, Mures County Clinical Hospital, Targu Mures, Romania
5. Diabetes Compartment/Mediaș Municipal Hospital, Mediaș, Romania
6. Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0030

Objective: The study investigated the association between markers of liver steatosis and fibrosis and the adherence to the Mediterranean dietary pattern, evaluated by a diet-quality score, in patients with type 2 diabetes (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods: Patients with T2DM and MASLD underwent a comprehensive medical evaluation, which included lifestyle, clinical, laboratory, and liver ultrasound assessment. The natural consumption of foods specific to the Mediterranean Diet (MedDiet) was investigated by a previously validated 14-item questionnaire (MedDiet Score). For the estimation of liver steatosis, the Index of NASH (Non-alcoholic steatohepatitis) (ION) was calculated by sex-specific formulas, while liver fibrosis was estimated by the Fibrosis-4 (FIB-4) score.
Results: Data from 271 patients were analyzed. The mean MedDiet Score was 4.55±1.59 points, and most patients scored 3 points (19.93%), 4 points (28.78%), and 5 points (21.40%). Patients with a MedDiet Score ≥5 points had lower fasting blood glucose, ferritin, C-peptide and HOMA-IR, and lower ION values (19.96 ±14.63 vs. 23.50±14.77; p=0.025). No significant differences were noted for FIB-4 values. MedDiet Score was negatively correlated with fasting blood glucose, ferritin, C-peptide, HOMA-IR, and ION values (r=-0.14 [-0.25; -0.01]; p=0.026), and positively with LDL cholesterol levels. Drinking less than one portion of sweet or carbonated beverages daily and eating at least 3 portions of nuts weekly was associated with lower ION values.
Conclusions: Low MedDiet Score was associated with markers of hepatic steatosis (but not fibrosis), worse insulin resistance, higher fasting hyperglycemia, and serum ferritin levels in patients with T2DM and MASLD.