Association Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Iron Deficiency Among Adults with Type 2 Diabetes Mellitus

Abstract

Objective: To determine the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and iron deficiency among adults with type 2 diabetes mellitus (T2DM).

Methodology: A comparative analytical cross-sectional study was conducted at King Edward Medical University, Lahore, from 1^st February, 2026 to 31^st July, 2026. A total of 106 adults with T2DM were recruited using consecutive sampling. MASLD was evaluated with hepatic ultrasonography and clinical criteria. Serum ferritin, complete blood count, serum iron, total iron-binding capacity, and transferrin saturation were used to evaluate iron status. The association between MASLD and iron deficiency was assessed using odds ratios, 95% confidence intervals (CIs), and logistic regression analysis.

Results: In the analysis, it was found that 64 (60.4%) participants had MASLD and 35 (33.0%) had iron deficiency. Participants with MASLD had significantly more iron deficiency (p=0.014). The unadjusted odds ratio was 3.10 (95% CI: 1.25–7.69). However, after adjustment for selected confounding factors, the association between MASLD and iron deficiency (p=0.046) persisted.

Conclusion: The findings suggest that iron deficiency may be more common in adults with T2DM with MASLD than in adults without MASLD.