New Study Links Body Weight and Liver Disease Risk in Patients with Diabetic Foot Ulcers

A recent study sheds new light on the intersection of metabolic liver disease and diabetes-related complications, revealing that nearly 40% of individuals with type 2 diabetes (T2DM) and diabetic foot ulcers (DFUs) also have metabolic dysfunction–associated steatotic liver disease (MASLD). This finding adds a critical layer to the understanding of how metabolic and vascular complications converge in high-risk diabetic populations.

While MASLD is already known to be highly prevalent among people with T2DM and obesity, this is the first study to specifically examine its frequency in patients with diabetic foot ulcers—a late-stage complication of diabetes associated with increased morbidity and healthcare costs. The results underscore the need for integrated screening and management strategies that consider not just one, but multiple organ systems affected by metabolic dysfunction.

The study enrolled 100 adults with type 2 diabetes and active foot ulcers, assessing their liver health through ultrasound imaging. MASLD—formerly referred to as nonalcoholic fatty liver disease (NAFLD)—was diagnosed in 39% of the cohort, with no significant difference between men and women. Importantly, the likelihood of MASLD increased markedly with rising body mass index (BMI): only 15% of participants with a BMI of 25 or lower had MASLD, compared to 50% of those in the overweight category (BMI 25–30), and a striking 69% of those classified as obese (BMI ≥30).

This gradient suggests a strong association between adiposity and hepatic fat accumulation in this already high-risk population. Moreover, individuals with MASLD also had a significantly higher rate of hyperlipemia (elevated blood lipids)—another known contributor to hepatic steatosis.

Interestingly, while MASLD prevalence aligned closely with increasing BMI, the study found that 40% of the participants were of normal weight, a figure higher than often reported in general T2DM populations. This raised important questions about whether patients with DFUs may represent a distinct metabolic phenotype—possibly reflecting catabolic states due to chronic inflammation or infection, or other underappreciated factors affecting body composition and metabolic reserve.

What makes these findings particularly relevant is the convergence of two major diabetes complications—foot ulcers and liver dysfunction—each with serious clinical consequences, yet rarely assessed together in routine care. DFUs are already associated with prolonged hospitalizations, risk of amputation, and higher mortality, while MASLD can silently progress to liver fibrosis, cirrhosis, and even hepatocellular carcinoma if left undetected.

This dual burden emphasizes the need for proactive screening for MASLD in patients with advanced diabetes complications, even in those without overt obesity. While BMI remains a strong predictor of liver disease risk, MASLD is fundamentally a multifactorial condition, influenced by insulin resistance, dyslipidemia, systemic inflammation, and genetic factors—all of which may be altered in patients with DFUs.

The authors call for more targeted research to understand the interplay between diabetes-related vascular disease, nutritional status, and hepatic fat accumulation, particularly in individuals with lower BMI who may not typically be flagged for liver disease screening. There is also a need to evaluate whether addressing MASLD in patients with DFUs could have a downstream impact on wound healing, infection rates, or overall metabolic control.

From a clinical standpoint, these findings suggest an opportunity to expand liver health assessments into diabetic foot clinics, especially given the non-invasive nature of ultrasound and the potential for early interventions—ranging from lifestyle modifications to emerging pharmacologic therapies for MASLD. A multidisciplinary approach that includes endocrinologists, hepatologists, wound care specialists, and nutritionists may be particularly well-suited to manage this complex patient population.

As the global burden of diabetes continues to grow, particularly in aging and overweight populations, recognizing and managing co-existing conditions like MASLD will be essential to improving long-term outcomes. This study contributes an important piece to that puzzle, highlighting the need to look beyond glucose control alone and address the broader metabolic dysfunctions that define the course of type 2 diabetes.