For millions of people, diabetes and fatty liver disease often exist quietly, causing little pain, few warning signs, and going undetected for years. But new research from India shows that when these two common conditions occur together, they can form a dangerous combination that sharply increases the risk of severe liver damage. The findings were published in the Journal of Clinical and Experimental Hepatology.
A large nationwide study conducted across 30 hospitals in India has found that people who have both diabetes and metabolic dysfunction–associated steatotic liver disease (MASLD), the new term for non-alcoholic fatty liver disease, face nearly double the risk of developing advanced liver scarring. This scarring, known as advanced fibrosis, can progress to cirrhosis, liver failure, or even liver cancer if left untreated.
MASLD and diabetes are both linked to problems in how the body handles sugar and fat. Each condition increases the likelihood of developing the other, but until now, scientists have not clearly understood how dangerous their coexistence could be. Given that fatty liver disease affects about one in three Indian adults and diabetes affects roughly one in ten, the combined risk represents a major public health concern.
To investigate this link, researchers from the Indian Consortium on MASLD followed thousands of patients across multiple cities for nearly five years. For this specific analysis, they closely examined 400 patients whose fatty liver disease had been confirmed through liver biopsy. Among them, 93 patients also had diabetes. The results were striking: 34 percent of patients with both conditions showed advanced fibrosis, compared to just 16.6 percent of those with MASLD alone—indicating a two-fold increase in risk.
According to lead investigator Dr. Ajay Duseja of PGIMER Chandigarh, not all fatty liver disease progresses in the same way. Some patients may remain stable for years. However, the presence of diabetes significantly accelerates liver damage and raises the chances of severe outcomes.
Supporting evidence from other Indian and international studies shows that patients with both diabetes and MASLD experience higher rates of liver complications, premature death, and reduced quality of life.
Early detection, good blood sugar control, and integrated treatment strategies could play a crucial role in preventing silent liver damage before it becomes life-threatening.
REFERENCE: Duseja, Ajay et al.; Indian National Association for Study of the Liver (INASL) Guidance Paper on Nomenclature, Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD); Journal of Clinical and Experimental Hepatology, Volume 13, Issue 2, 273 – 302; DOI: 10.1016/j.jceh.2022.11.014
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