Metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus in Tanzania: prevalence and predictors

BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly recognized metabolic disorder worldwide but remains poorly characterized in sub-Saharan Africa. Individuals with type 2 diabetes mellitus (T2DM) are at particularly high risk. This study assessed the prevalence, and predictors of MASLD among individuals with T2DM in Tanzania using transient elastography, for measuring hepatic fat accumulation. METHODS: A cross-sectional study was conducted from December 2023 to March 2024 at Bugando Medical Centre in Mwanza, Tanzania, involving 254 adults with T2DM. Demographic, clinical, and biochemical data were collected through interviews and medical procedures. Hepatic steatosis was quantified using transient elastography, and MASLD was diagnosed based on elevated liver fat attenuation. Logistic regression analysis was performed to measure predictors of MASLD. RESULTS: The median age of participants was 62 years (IQR55–68), and 64% were female. The overall prevalence of MASLD was 51.6%, and more than half of the affected individuals had severe steatosis. Lean MASLD (body mass index below 25 kg/m²) accounted for about 10% of all cases, with a similar degree of severity as in overweight or obese participants. Female sex, increased waist circumference, and elevated diastolic blood pressure were predictors of MASLD, while liver enzyme levels did not differ significantly between individuals with and without MASLD. CONCLUSIONS: MASLD is highly prevalent (51.6%) and often severe among Tanzanian individuals with T2DM, affecting both obese and lean individuals. Female sex, waist circumference > 102 cm in men and 88 cm in females, and diastolic blood pressure > 80 mmHg are major predictors. These findings highlight the need to urgently integrate liver health assessment into diabetes management in sub-Saharan Africa. CLINICAL TRIAL NUMBER: Not applicable.