Prevalence and Risk Factors of MASLD in Prediabetes and Type 2 Diabetes Mellitus in Belgium and The Netherlands

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely intertwined with glucose metabolism status (GMS). Bi-national comparative epidemiological data are lacking; therefore, this study aimed to provide new insights into MASLD and fibrosis prevalence and risk factors in Belgium, while comparing data from The Netherlands to uncover cross-country differences. Materials and Methods: A prospective cohort study (2019-2024) in Belgian primary and secondary care was compared with the Dutch Maastricht Study. Liver fat was measured using CAP (FibroScan (R)), and anthropometric, clinical, and biochemical data were collected. Associations with CAP were analysed using multivariable linear regression, including sex, age, BMI, MetS, high SBP, CVD history, and country. Results: A total of 2436 individuals (Belgium and The Netherlands) were screened, of which 1928 were eligible: MASLD with normal GMS (38.3%), prediabetes (19.2%), and type 2 diabetes mellitus (T2DM; 42.5%). Belgian participants with T2DM had higher BMI and prevalence of MASLD. CAP values were significantly associated with female sex (-7.5 dB/m, 95%CI (-11.834; -3.056), p < 0.001), BMI (5.184 dB/m, 95%CI (4.627; 5.741), p < 0.001), and MetS (13.7 dB/m, 95%CI (8.456; 18.994), p < 0.001). Country-specific interactions showed differing effects of high SBP and CVD on CAP between Belgium and The Netherlands, with only the inverse association of CVD history (-10.756, 95%CI (-17.485; -4.027), p = 0.002) with CAP in The Netherlands being significant. Conclusions: MASLD and fibrosis are common in people with prediabetes and T2DM, underscoring the need for early detection and management. Obesity and metabolic risk were key factors, while a history of CVD appeared protective in the Dutch cohort but not in the Belgian one.