Joint Impact of Body Mass Index and High-Sensitivity C-Reactive Protein on Metabolic Dysfunction–Associated Steatotic Liver Disease Risk in Type 2 Diabetes

Abstract

Background and Aims:

Prospective data on the joint impact of adiposity and systemic inflammation on incident metabolic dysfunction–associated steatotic liver disease (MASLD) in type 2 diabetes (T2D) are limited. We examined the individual and combined associations of body mass index (BMI) and high-sensitivity C-reactive protein (hsCRP) with incident MASLD in patients with T2D.

Materials and Methods:

This prospective cohort study included 2796 adults with T2D free of MASLD from the Kailuan study (China). Over a 14-year follow-up, participants were classified by baseline BMI: (<24 vs. ≥24 kg/m²) and hsCRP (<3 vs. ≥3 mg/L). Multivariable Cox models estimated hazard ratios (HRs) for incident ultrasonographic steatosis.

Results:

The cumulative incidence of MASLD was 53.9%. Higher BMI: and hsCRP were independently associated with increased risk. In joint analyses, the high BMI/high hsCRP group had the highest risk [adjusted HR: 2.31; 95% confidence interval (CI): 1.94–2.74] compared with the low BMI/low hsCRP group. This risk was greater than isolated high hsCRP (HR: 1.37) or isolated high BMI: (HR: 1.93).

Conclusions:

Elevated BMI: and hsCRP are independently associated with incident MASLD in T2D. Co-elevation of both factors confers the greatest risk, suggesting that incorporating both adiposity and inflammatory markers improves risk stratification for targeted preventive strategies.