Integrating MASLD detection into diabetes care in primary care settings in Mexico: A cascade analysis

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) remains underrecognised in diabetes care due to the lack of structured detection pathways in primary healthcare. OBJECTIVE: To evaluate the feasibility and performance of a stepwise diagnostic pathway for identifying the full spectrum of MASLD in adults with type 2 diabetes in primary healthcare settings. METHODS: A diagnostic pathway for early detection across the MASLD spectrum, including steatosis, metabolic dysfunction-associated steatohepatitis (MASH), liver fibrosis risk and significant fibrosis, was integrated into a multicomponent diabetes care programme within the public health system. A secondary exploratory analysis used multivariable logistic regression to identify factors independently associated with MASLD. RESULTS: Among 454 adults with type 2 diabetes, MASLD was identified in 51.5% and MASH in 22.2%. Through stepwise assessment, 22.7% showed intermediate-to-high fibrosis risk, and among those who underwent transient elastography, significant fibrosis was confirmed in 27.9% of individuals with increased risk, yielding an estimated prevalence of 10.6% in the MASLD group and 5.9% overall. In multivariable analysis, female sex, elevated liver enzymes and higher body mass index were independently associated with MASLD, with a non-linear association across BMI categories. CONCLUSION: Implementing structured care pathways for the identification and management of MASLD is feasible and essential to mitigate the burden of diabetes and liver disease. Strengthening primary care capacity remains crucial for systematic integration of MASLD identification in routine care.