What question did this study set out to answer?

The aim was to develop and validate a non-invasive model to identify individuals with at-risk metabolic dysfunction-associated steatohepatitis (MASH) in type 2 diabetes.

June 7, 2026

2217-P: DiabetesMASH Index for Noninvasive Identification of At-Risk Metabolic Dysfunction–Associated Steatohepatitis in Type 2 Diabetes

Key Points

The aim was to develop and validate a non-invasive model to identify individuals with at-risk metabolic dysfunction-associated steatohepatitis (MASH) in type 2 diabetes.
A multicenter derivation cohort of 525 individuals undergoing liver biopsy was used for model development.
Validation was conducted using transient elastography-based cohorts from China (3,711), Singapore (422), and the US NHANES (1,674).
At-risk MASH was defined by liver biopsy in the derivation cohort and the FibroScan-aspartate aminotransferase (FAST) score in validation cohorts.
The DiabetesMASH Index (DMI) showed AUROC of 0.79 in the derivation cohort and 0.91, 0.88, and 0.90 in validation cohorts, respectively (95% CI range from 0.75 to 0.94).
Sensitivity was 85% with a negative predictive value of 92% at a rule-out threshold of 0.184, while specificity was 90% with a positive predictive value of 57% at a rule-in threshold of 0.452.
The indeterminate zone was 35.8% in the derivation cohort and ranged from 19.1% to 24.8% in validation cohorts.

Abstract

Introduction and Objective: Metabolic dysfunction-associated steatohepatitis (MASH) is highly prevalent among individuals with type 2 diabetes (T2D) and significantly increases the risk of liver-related events. Individuals with at-risk MASH (MASH+F2-4) are the main target for emerging therapies. We aimed to develop and validate a non-invasive model to identify at-risk MASH in adults with T2D. Methods: A multicenter derivation cohort undergoing liver biopsy (n=525) was used for model development. External validation was conducted in three transient elastography-based cohorts: a Chinese cohort (n=3,711), a Singapore cohort (n=422), and a US NHANES cohort (n=1,674). At-risk MASH was defined histologically in the derivation cohort and by the FibroScan-aspartate aminotransferase (FAST) score in validation cohorts. Performance was compared with the Fibrosis-4 index (FIB-4), non-alcoholic fatty liver disease fibrosis score (NFS), and AST/alanine aminotransferase (ALT) ratio (AAR). Results: The DiabetesMASH Index (DMI), which incorporates age, waist circumference, ALT, and hemoglobin A1c, showed satisfactory discrimination in the derivation cohort (AUROC 0.79; 95% CI 0.75 - 0.83) and validation cohorts (AUROC 0.91 95% CI 0.89 - 0.94, 0.88 0.80 - 0.96, and 0.90 0.86 - 0.94), outperforming the FIB-4, NFS, and AAR. Calibration analyses showed agreement between predicted and observed risks. Rule-out and rule-in thresholds were 0.184 (sensitivity 0.85; negative predictive value NPV 0.92) and 0.452 (specificity 0.90; PPV 0.57). The indeterminate zone accounted for 35.8% of patients in the derivation cohort and 19.9%, 24.8%, and 19.1% in validation cohorts. Conclusion: DMI is a validated, affordable, and accessible non-invasive tool for identifying at-risk MASH in T2D. Disclosure Y. Chen: None. B. Dong: None. C. Liu: None. Z. Li: None. M. Zheng: None. K. Chen: None. G. Goh: None. B. Ye: None. X. Liang: None. A. Hu: None. Y. Li: None. Q. Zeng: None. Y. Sun: None. W. Gou: None. H. Bian: None. J. Lv: None. J. Shen: None. X. Liang: None. X. Zhou: None. M. Huang: None. Q. Zhang: None. Y. Wang: None. X. Xiao: None. Y. Wang: None. Y. Qi: None. Y. Zhou: None. J. He: None. Z. Dai: None. X. Qi: None. Funding The Key Research and Development Program of Jiangsu Province (BE2023767a), the Health Research Program of Anhui (AHWJ2023A30169), and the Natural Science Foundation of Anhui Province (2508085QH314)

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2217-P: DiabetesMASH Index for Noninvasive Identification of At-Risk Metabolic Dysfunction–Associated Steatohepatitis in Type 2 Diabetes

Key Points

Abstract

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