ArticleFrontiers in endocrinology2026
Association of one-hour postload plasma glucose combined with metabolic dysfunction-associated steatotic liver disease and FIB-4 screening positivity with elevated LDL cholesterol and cerebrovascular stenosis.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in type 2 diabetes mellitus (T2DM) and amplifies cardiovascular and metabolic burden. Elevated low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cerebrovascular stenosis, and MASLD-mediated hepatic lipid dysregulation is closely linked to LDL-C metabolism. One-hour postload plasma glucose (1h-PG) reflects early beta-cell dysfunction and may synergistically contribute to cerebrovascular injury alongside the MASLD/FIB-4 phenotype. Methods: This single-center retrospective cross-sectional study enrolled 312 treatment-naïve adults with newly diagnosed T2DM, of whom 278 completed a standardized 75-g oral glucose tolerance test (OGTT; age 24-78 years). The primary outcome was ultrasound-confirmed MASLD combined with age-specific FIB-4 screening positivity (age <65 years: FIB-4 ≥1.30; age ≥65 years: FIB-4 ≥2.00). Secondary outcomes included elevated LDL-C (≥3.4 mmol/L) and cerebrovascular stenosis (≥50% luminal narrowing in major intracranial or extracranial arteries). Results: Overall, 199 participants (71.6%) had MASLD and 64 (23.0%) met the primary outcome. Those meeting the primary outcome had significantly higher 1h-PG (17.7 ± 3.7 vs. 14.9 ± 3.8 mmol/L; P<0.001), with an adjusted OR of 1.15 per 1-mmol/L increment (95% CI 1.05-1.26; P = 0.003). Elevated LDL-C was present in 73 participants (26.3%) and cerebrovascular stenosis in 49 (17.6%). The composite group of high 1h-PG (≥Q3) plus MASLD/FIB-4 positivity had the highest stenosis rate (34.8% vs. 6.0%), with an adjusted OR of 2.61 (95% CI 1.23-5.55; P = 0.012). Adding LDL-C attenuated the OR from 3.42 to 2.61 (~24%), indicating partial mediation. The AUC improved from 0.661 (1h-PG alone) to 0.726 (combined model). Conclusions: In newly diagnosed T2DM, elevated 1h-PG was associated with MASLD/FIB-4 positivity; their combination was further linked to higher LDL-C and increased cerebrovascular stenosis risk, with LDL-C potentially acting as a partial mediator. The combined model showed improved discriminative ability, though validation in larger multicenter cohorts remains warranted.
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