Factors Associated with MASLD Resilience in Type 2 Diabetes: A Prospective Study Integrating Longitudinal MRI/MRE Imaging and Stable Isotope Tracing
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Date
2026
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Abstract
Background & Aims Type 2 diabetes is one of the strongest factors contributing to the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). In this study, we aimed to identify factors associated with MASLD resilience in a prospective cohort of individuals with type 2 diabetes.MethodsThis is a prospective study including 148 individuals with type 2 diabetes who underwent advanced liver phenotyping using MRI and MRE techniques at baseline and 2-year follow-up. MASLD resilience was defined by imaging absence of hepatic steatosis (MRI-PDFF < 5%) and significant fibrosis (MRE < 3 kPa) at both time points. Factors associated with MASLD resilience were assessed using Firth’s penalized logistic regression. Regularized logistic regression models were fitted as complementary analyses.ResultsThe mean (SD) age and body mass index (BMI) were 65 (8) years and 30.4 (4.3) kg/m2, respectively. After a median follow-up of 2 (1.5–2.4) years, 27 (18%) individuals demonstrated MASLD resilience. Across all modeling approaches, lower BMI (odds ratio [OR] 0.81, 95% CI 0.64–0.98; p=0.029), lower HOMA-IR (OR 0.59, 95% CI 0.39–0.83; p=8.6e-4), and lower circulating triglycerides (OR 0.986, 95% CI 0.973–0.997; p=0.011) emerged as the strongest predictors of MASLD resilience. An exploratory analysis of 11 individuals with type 2 diabetes from an independent cohort, with hepatic de novo lipogenesis (DNL) quantified by stable isotope tracing, revealed lower hepatic DNL in those free from MASLD.