Earlier MASLD Onset Associated With Higher Long-Term Risk of Type 2 Diabetes
Earlier onset of metabolic dysfunction-associated steatotic liver disease (MASLD) was associated with a substantially greater risk of developing type 2 diabetes (T2D), according to findings from a large prospective cohort study. The results suggest that age at MASLD onset may be an important factor in diabetes risk stratification and reinforce the importance of early prevention.
Investigators analyzed data from the Kailuan Study, which included 58,814 participants free of both MASLD and T2D at baseline between 2006 and 2007. By the end of 2015, 29,016 participants had developed MASLD and were randomly matched with MASLD-free controls by age and sex. After excluding individuals who developed T2D within the first two years of follow-up, the final analysis included 19,378 participants with incident MASLD and 19,483 controls.
Participants were followed through December 2020, with a median follow-up of 11.8 years. During that period, 2301 incident cases of T2D were documented.
Compared with participants who did not develop MASLD, those diagnosed before age 40 had the greatest risk of subsequent T2D (hazard ratio [HR], 6.18; 95% CI, 4.28-8.93). The magnitude of risk declined progressively with older age at MASLD onset, although it remained significantly elevated across all age groups: ages 40 to younger than 50 years (HR, 3.29), 50 to younger than 60 years (HR, 3.14), 60 to younger than 70 years (HR, 2.94), and 70 years or older (HR, 2.17).
The authors concluded that “MASLD onset at any age is associated with increased risk of T2D, with earlier onset conferring progressively greater risk.” They added that the findings “highlight the importance of preventing, or at least delaying MASLD onset, particularly in young adults.”
Reference
Huo Z, Li Y, Liu T, et al. Association of metabolic dysfunction-associated steatotic liver disease onset age with risk of incident type 2 diabetes. Clin Gastroenterol Hepatol. Published online July 4, 2026. doi:10.1016/j.cgh.2026.06.028
