RELATIONSHIP BETWEEN FIBROSIS SCORES AND FERRITIN, VITAMIN D, AND MAGNESIUM IN TYPE 2 DIABETES–RELATED HEPATIC STEATOSIS

Abstract

Objective: Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent in type 2 diabetes mellitus (T2DM) and is closely linked to progressive liver fibrosis.This study evaluated the association between ultrasonographically assessed hepatic steatosis severity, non-invasive fibrosis scores, and the metabolic biomarkers ferritin, vitamin D, and magnesium in patients with T2DM-associated MASLD. Methods: In this retrospective observational cohort study, T2DM patients with available abdominal ultrasonography were classified by steatosis grade (Grade 1–3). Non-invasive fibrosis scores (FIB-4, APRI, Forns index, and S-index) were calculated, and serum ferritin, 25-hydroxyvitamin D, and magnesium were analyzed. Associations were assessed by univariate and multivariable regression adjusting for age and sex. Results: FIB-4, Forns index, and S-index were significantly higher in MASLD patients than in healthy controls, but no consistent stepwise increase was observed across steatosis grades. In univariate analyses, higher ferritin was associated with higher fibrosis scores, magnesium declined with increasing severity, and vitamin D showed a weak positive correlation with FIB-4. After adjustment for age and sex, the associations of all three biomarkers lost statistical significance, and age remained the most robust determinant of fibrosis severity. Conclusion: In T2DM-associated MASLD, non-invasive fibrosis scores were elevated compared with controls without a consistent gradient across steatosis grades. Ferritin and vitamin D were associated with fibrosis only in univariate analyses and were not independent predictors after demographic adjustment, suggesting they reflect underlying metabolic and age-related characteristics rather than fibrosis progression itself.