A Prospective Study on the Prevalence of MASLD in Patients With Type 2 Diabetes and Hyperferritinaemia

ABSTRACT Background Elevated levels of serum ferritin, a marker of hepatic iron overload and inflammation, may be associated with metabolic dysfunction‐associated steatotic liver disease (MASLD) and hepatic fibrosis. Aim To determine the prevalence of MASLD and significant hepatic fibrosis among patients with type 2 diabetes mellitus (T2DM) and hyperferritinaemia. Methods This is a cross‐sectional analysis of a prospective cohort of 523 adults (64% female) aged 50–80 with T2DM and without a diagnosis of haemochromatosis. MASLD and significant fibrosis were defined as magnetic resonance imaging‐proton density fat fraction (MRI‐PDFF) ≥ 5% and magnetic resonance elastography (MRE) ≥ 3.0 kPa, respectively. Hyperferritinaemia was defined as serum ferritin ≥ 200 ng/mL in females or ≥ 300 ng/mL in males. The primary objective was to determine the prevalence of MASLD and significant fibrosis in hyperferritinaemia. Results The mean age and body mass index were 64.1 (±8.1) years and 31.5 (±5.9) kg/m 2 , respectively. The overall prevalence of hyperferritinaemia was 20.5% ( n = 107). The prevalence of MASLD (78.5% vs. 62.1%, p = 0.001) and significant fibrosis (35.5% vs. 22.1%, p = 0.002) were higher in participants with hyperferritinaemia than those without. Hyperferritinaemia remained an independent predictor of MASLD (OR 2.01; 95% CI 1.19–3.39; p = 0.009) and significant fibrosis (OR 2.33; CI 1.43–3.77; p = 0.001), even after adjustment for age, sex, obesity and insulin use. Conclusion Approximately 80% of people with hyperferritinaemia and T2DM have MASLD, and more than a third have significant hepatic fibrosis. Hyperferritinaemia may be a useful biomarker for MASLD and significant fibrosis in people with T2DM.