MASLD in patients with type 2 diabetes mellitus in Argentina: the need for regional evidence for a growing metabolic epidemic

Abstract

Metabolic dysfunction–associated steatotic liver disease (MASLD) has become the most common cause of chronic liver disease worldwide and is expected to be one of the main determinants of cirrhosis, hepatocellular carcinoma, and liver-related mortality in the coming decades^1,2. Within this context, type 2 diabetes mellitus (T2DM) emerges as one of the clinical factors most strongly associated with the presence and progression of MASLD, with estimated prevalences ranging from 50% to 70% across different international cohorts^6,7,8.

In this setting, the Argentine multicenter study “Prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus”¹⁰ provides particularly relevant data for Argentina and Latin America. These findings are highly valuable, as they are multicenter and were generated and funded by a scientific society. They represent a useful tool to raise awareness of the problem, overcome clinical inertia, and support discussions with health authorities, payers, and the media, which often lack local data.

The universal application of global algorithms poses significant challenges when extrapolated to populations with different demographic and metabolic characteristics. Most cutoff values used for noninvasive methods were derived from predominantly Caucasian European or North American cohorts. In contrast, recent studies have shown that, in Hispanic and Latin American populations, the diagnostic accuracy of these methods may vary, highlighting the need to validate and potentially adjust cutoff values in regional settings^3,4.

At the same time, recent multinational studies have demonstrated that the diagnostic accuracy of noninvasive methods may be influenced by specific clinical variables such as age, obesity, and the presence of diabetes⁴. In a global analysis including more than 18,000 patients with MASLD, the performance of FIB-4 was shown to decline significantly with age and may require adjusted cutoff values, whereas liver elastography demonstrated greater diagnostic stability, although with variations associated with body mass index (BMI)^4,5. This observation has important clinical implications, as it reinforces the concept that diabetes identifies a high-risk population that should be actively evaluated, but does not necessarily require different diagnostic thresholds for liver elastography.

In an Argentine multicenter cohort of patients with MASLD undergoing liver biopsy, liver elastography showed excellent diagnostic accuracy for detecting significant and advanced fibrosis, although the optimal cutoff values differed from those reported in Europe and the United States⁵.

These findings underscore the need to generate local evidence to adapt global diagnostic strategies to the epidemiological characteristics of each region. Latin America presents relevant demographic and metabolic particularities, including a high prevalence of obesity, diabetes, and genetic variants associated with MASLD, such as PNPLA3, which may influence the natural history of the disease^6,7,8.

In Argentina, the availability of multicenter epidemiological studies on MASLD remains limited. Therefore, research such as that presented in this issue has strategic value not only for the medical community but also for the development of public health policies.

From a clinical perspective, the results of this study support the implementation of systematic screening strategies for liver fibrosis in patients with T2DM, using stepwise algorithms that combine simple serum biomarkers with imaging methods¹². Another relevant finding is the low use of liver elastography in real-world practice, raising concerns about the applicability of guideline-recommended strategies in the context of health authorities and payers.

In this regard, the increasing prevalence of obesity and T2DM in our setting has led to a rise in cirrhosis associated with metabolic dysfunction, along with its complications and the consequent reduction in survival, making it a major public health concern.

In Argentina, the only nationwide registry of cirrhosis cases currently available is that conducted by the Argentine Society of Hepatology (SAHE) through the National Observatory of Liver Diseases (ONEH), within the project “Systematization and collection of cirrhosis data in the Argentine Republic.” In the preliminary report of this registry, presented at the XXIII Argentine Congress of Hepatology 2025 and published on the SAHE website, 281 cases of cirrhosis diagnosed between January 1, 2025, and October 15, 2025, were included, with participation from 21 of the 24 jurisdictions of the country. The most frequently reported etiology was MASLD, accounting for 37% of cases, associated with T2DM in 63% and with dysglycemia without diabetes in 11%. Overweight and obesity were present in 92% of evaluated patients, and the coexistence of T2DM and overweight/obesity was observed in 60%. The association between metabolic dysfunction and moderate alcohol consumption, referred to as MetALD, accounted for 9% of cirrhosis cases, associated with diabetes in 32% and dysglycemia without diabetes in 18%. In these cases, overweight and obesity were present in 95% of patients⁹.

Finally, the study published in this issue is aligned with the recommendations of the Argentine guidelines on fatty liver disease published by SAHE, which emphasize the need to recognize MASLD as a systemic metabolic disease and promote the use of noninvasive methods for the assessment of liver fibrosis in clinical practice¹².

In conclusion, the Argentine multicenter study on the prevalence of MASLD in patients with T2DM represents a relevant and landmark contribution to regional epidemiological knowledge. Its findings reinforce the need to develop diagnostic and screening strategies adapted to the characteristics of Latin American populations. In an era marked by the globalization of metabolic hepatology, the generation of local evidence will be essential to optimize the clinical management of MASLD and reduce the growing burden of liver disease in our region—echoing the timeless importance of “painting one’s own village