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We investigated the association between hepatic steatosis quantified by controlled attenuation parameter (CAP) and the development of type 2 diabetes mellitus (T2DM) in a health checkup population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The present retrospective cohort study included 1636 participants without T2DM who underwent CAP measurement and were followed up at annual health checkups. Cox proportional hazards regression was used to identify risk factors for T2DM development.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During a mean follow\u2010up of 3.2\u00a0years, 181 participants developed T2DM. The cumulative incidence rates of T2DM were significantly higher in participants with severe steatosis (CAP\u00a0\u2265\u00a0280\u00a0dB\/m) compared with those without (13.9% vs. 4.8% at 3\u00a0years, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Multivariate analysis identified CAP as an independent predictor of new\u2010onset T2DM (adjusted hazard ratio [aHR], 1.04 per 10\u00a0dB\/m increase; 95% confidence interval [CI], 1.01\u20131.08, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.01), along with fasting plasma glucose (aHR, 2.13 per 10\u00a0mg\/dL; 95% CI, 1.77\u20132.55, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), HbA1c (aHR, 1.25 per 0.1% increase; 95% CI, 1.19\u20131.32, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), and platelet count (aHR, 0.95 per 10<jats:sup>4<\/jats:sup>\/\u03bcL increase; 95% CI, 0.92\u20130.98, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001). A dose\u2013response relationship was observed between CAP level and T2DM risk. In addition, suspected compensated advanced chronic liver disease (liver stiffness \u226510\u00a0kPa) and at\u2010risk steatohepatitis (FibroScan\u2010AST score \u22650.67) were associated with a higher incidence of T2DM (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001 for both).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CAP quantification of hepatic steatosis effectively stratifies the risk of developing T2DM, facilitating timely intervention and prevention strategies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hepr.14216","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T07:24:41Z","timestamp":1748589881000},"page":"1101-1110","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Predicting the risk of developing diabetes in steatotic liver disease using controlled attenuation parameter in a health checkup population"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5727-5385","authenticated-orcid":false,"given":"Takuma","family":"Nakatsuka","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Yamaji","sequence":"additional","affiliation":[{"name":"Health Development Center Tokyo Pharmaceutical Industry Health Insurance Society  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3021-2517","authenticated-orcid":false,"given":"Ryosuke","family":"Tateishi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Graduate School of Medicine The University of Tokyo  Tokyo 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