Metabolic Dysfunction-Associated Steatotic Liver Disease prevalence reaches 56.9% among diabetic adults in IndiaMore than half of Indian adults with Type 2 Diabetes have liver disease

Background and objectives This systematic review seeks to assess the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM) within the Indian population. Methods A comprehensive search of SCOPUS, Web of Science and PubMed was performed for studies published from January 2000 to March 2025, using search terms such as MASLD, T2DM, NAFLD, steatohepatitis and India. This systematic review considered eligible Indian studies that included patients (≥18 years old) with T2DM and reported the prevalence of MASLD/NAFLD. The study excluded reviews, case reports, conference abstracts, editorials, and studies that did not have full texts. Pooled MASLD prevalence determined by liver biopsy, transient elastography, ultrasound, or biochemical markers was the main result. Prevalence estimates were combined using a random-effects model, and quality was evaluated using the Joanna Briggs Institute approach. Results Across the 18 selected studies, the pooled prevalence of MASLD was estimated from 81,364 adult diabetic participants. In diabetic adults, the estimated pooled prevalence of MASLD was 56.9% [95% Confidence interval (CI), 39.1-74.8]. Among these studies, the prevalence by biochemical marker was 50.4% (95% CI 38.6 - 62.2), the prevalence by ultrasonography was 55.6% (95% CI 37.1 - 74.1), and the prevalence by Fibroscan as an imaging modality was 64.3% (95% CI 31 - 97.7). Several limitations were noted; many studies provided insufficient information regarding cohort representativeness, selection criteria for non-exposed groups, and the adequacy of follow up. Interpretation and conclusions While awareness of MASLD is increasing among diabetic populations globally, data concerning its prevalence and clinical characteristics in the Indian population-especially within regional demographics-remains limited. The variability in reported prevalence rates, ranging from 34 to 94%, among individuals with T2DM indicates a pressing need for region-specific research that considers the diverse ethnic backgrounds, diets, and lifestyles throughout India.