Multifactorial Risk Control Lowers Liver Disease Burden in Type 2 Diabetes, Study Shows
China: Patients with type 2 diabetes (T2D) face a substantially higher risk of developing severe metabolic dysfunction-associated steatotic liver disease (MASLD) and major adverse liver outcomes (MALO). However, this risk can be significantly reduced when multiple lifestyle and clinical factors are simultaneously controlled, a large prospective cohort study published in BMJ Open Diabetes Research & Care has revealed.
The study, led by Wenfei Xia, MD, from the Department of Breast and Thyroid Surgery, Huazhong University of Science and Technology, Tongji Medical College, Tongji Hospital, Wuhan, China, and colleagues, examined the role of multifactorial risk management in modifying liver disease outcomes among individuals with T2D.
The researchers found that patients with better control over a combination of risk factors—including diet, smoking, alcohol intake, physical activity, sedentary behavior, body mass index (BMI), glycated hemoglobin (HbA1c), blood pressure, and LDL cholesterol—showed progressively lower excess risk of severe liver complications.
The analysis included 307,688 participants from the UK Biobank, followed for a median of 12.5 years. It led to the following findings:
- During the study, 519 participants with diabetes (3.9%) and 2,718 without diabetes (0.9%) developed severe MASLD.
- Individuals with type 2 diabetes had nearly a fourfold higher risk of severe MASLD compared to those without diabetes (hazard ratio 3.93).
- The excess risk decreased progressively with a greater number of well-controlled risk factors.
- Participants with zero to two controlled risk factors had a 5.4-fold higher risk, while those with seven to nine controlled factors had a reduced excess risk of 2.6-fold.
- A similar pattern was observed for major adverse liver outcomes (MALO), highlighting the protective effect of multifactorial control.
These findings underline the value of comprehensive care in diabetes management. Rather than focusing on isolated parameters such as blood sugar or cholesterol alone, targeting a broader spectrum of modifiable factors may significantly curb liver-related complications. “Patients with type 2 diabetes who achieved a greater number of risk factors within target ranges had progressively lower excess risk of severe MASLD and MALO,” the authors reported, suggesting that holistic lifestyle and clinical interventions could translate into meaningful long-term benefits.
The study is particularly notable for its large sample size and long-term follow-up, providing robust evidence for the role of multifactorial control. However, the researchers acknowledged several limitations, including reliance on self-reported lifestyle data, the lack of longitudinal updates on risk factor changes, and the predominantly Caucasian population of the UK Biobank, which may limit the generalizability of the findings to other ethnic groups. Additionally, as an observational study, the results cannot definitively establish causality.
Despite these caveats, the findings strengthen the case for integrating multifactorial risk management into diabetes care guidelines. They suggest that structured interventions targeting multiple lifestyle and clinical parameters could play a critical role in reducing the burden of diabetes-related liver diseases.
"The study highlights that while patients with T2D remain at elevated risk of severe liver complications, comprehensive management of diverse health behaviors and clinical markers can meaningfully reduce this risk. This evidence supports a shift towards more holistic diabetes care strategies that prioritize multiple domains of risk factor control to improve long-term outcomes," the authors concluded.
Reference:
Chen R, Zhou Y, Xu M, Gong Y, Xia W, Yin X. Association between multifactorial control and excess risk of liver diseases in type 2 diabetes: a prospective cohort study. BMJ Open Diabetes Research & Care. 2025;13:e005336. https://doi.org/10.1136/bmjdrc-2025-005336
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