Diabetes and metabolic dysfunction-associated fatty liver disease

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a relatively novel classification which downplays the importance of alcohol in the definition of non-alcoholic fatty liver disease (NAFLD) and emphasizes the metabolic risk factors that underlie progression of NAFLD-associated pathology. All people with type 2 diabetes (T2D) and hepatic fat content >5% by biomarkers, imaging or biopsy are considered to have MAFLD. Since there have been very few published studies of MAFLD in diabetes, the present review assesses contemporary methods for quantifying liver fat and fibrosis (including those based on magnetic resonance imaging) with special reference to T2D, their prognostic implications for people with T2D and MAFLD, and the factors and interventions that modify disease progression and outcomes. The changing epidemiology of obesity and cardiovascular disease and new therapies for MAFLD on the horizon with potential implications for T2D are discussed.