{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T03:25:06Z","timestamp":1783740306256,"version":"3.55.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Metabolic associated fatty liver disease (MAFLD) is a leading cause of chronic liver disease worldwide, with heightened prevalence and progression risks in individuals with type 2 diabetes mellitus (T2DM). Emerging evidence suggests dietary factors, particularly sugar-sweetened beverage (SSB) consumption, may exacerbate metabolic dysregulation, yet this relationship remains underexplored in MAFLD populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We enrolled 3,305 T2DM patients from Taizhou University Hospital, classifying them into MAFLD and non-MAFLD groups via liver ultrasonography. SSB consumption was quantified as weekly intake. Clinical parameters and SSB consumption were analyzed using logistic regression. External validation leveraged NHANES data, focusing on total sugar intake and surrogate markers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>MAFLD patients exhibited significantly higher BMI, waist\/hip ratios, and SSB consumption than non-MAFLD counterparts (p&amp;lt;0.001). SSB consumption emerged as an independent MAFLD risk factor, with dose-dependent escalation in MAFLD odds. The MAFLD model based on glycometabolism (MMBG), integrating SSB consumption, C-peptide, and glucose, outperformed traditional indices, such as TyG, VAI, and AIP, achieving superior AUC (0.712 vs. 0.631\u20130.666), enhanced clinical utility and higher Brier scores (p&amp;lt;0.05, respectively). NHANES validation confirmed BMI, central obesity, hyperglycemia, and sugar intake as MAFLD predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>SSB consumption independently predicts MAFLD risk in T2DM patients, with synergistic effects from dysregulated glycometabolism. The MMBG model, incorporating SSB consumption and glycometabolic parameters, offers a robust tool for early MAFLD risk identification and personalized interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1651370","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T04:17:04Z","timestamp":1759292224000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Sugar-sweetened beverage consumption predicts metabolic associated fatty liver disease in patients with type 2 diabetes mellitus"],"prefix":"10.3389","volume":"16","author":[{"given":"Zhenjun","family":"Yu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengdie","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shicheng","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaohui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.03.039","article-title":"A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement","volume":"73","author":"Eslam","year":"2020","journal-title":"J J Hepatol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of nafld worldwide: A systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"J Lancet Gastroenterol hepatol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1969","article-title":"Impact of the new definition of metabolic dysfunction\u2013associated fatty liver disease on detection of significant liver fibrosis in us adolescents","volume":"6","author":"Ciardullo","year":"2022","journal-title":"J Hepatol Commun"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30039-1","article-title":"Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in asia, 1999\u20132019: A systematic review and meta-analysis","volume":"4","author":"Li","year":"2019","journal-title":"J Lancet Gastroenterol hepatol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.3390\/ijerph17061818","article-title":"Prevalence and risk factors of metabolic associated fatty liver disease in xinxiang, China","volume":"17","author":"Li","year":"2020","journal-title":"J Int J Environ Res Public Health"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1042\/CS20220572","article-title":"Molecular mechanisms of metabolic associated fatty liver disease (mafld): Functional analysis of lipid metabolism pathways","volume":"136","author":"Badmus","year":"2022","journal-title":"J Clin Sci"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-1778","article-title":"High prevalence of advanced liver fibrosis assessed by transient elastography among us adults with type 2 diabetes","volume":"44","author":"Ciardullo","year":"2021","journal-title":"J Diabetes Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"399","DOI":"10.2337\/dc20-1997","article-title":"Advanced liver fibrosis is common in patients with type 2 diabetes followed in the outpatient setting: The need for systematic screening","volume":"44","author":"LoMonaco","year":"2021","journal-title":"J Diabetes Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2184","DOI":"10.4254\/wjh.v7.i19.2184","article-title":"Targeting kupffer cells in non-alcoholic fatty liver disease\/non-alcoholic steatohepatitis: Why and how? J","volume":"7","author":"Lanthier","year":"2015","journal-title":"World J Hepatol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2019.34.3.226","article-title":"Nonalcoholic fatty liver disease and diabetes: An epidemiological perspective","volume":"34","author":"Rhee","year":"2019","journal-title":"J Endocrinol Metab"},{"key":"B11","doi-asserted-by":"publisher","first-page":"968","DOI":"10.3390\/jcm11040968","article-title":"Non-alcoholic fatty liver disease and risk of macro-and microvascular complications in patients with type 2 diabetes","volume":"11","author":"Mantovani","year":"2022","journal-title":"J J Clin Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-313884","article-title":"Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases","volume":"66","author":"Adams","year":"2017","journal-title":"J Gut"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000432","article-title":"Duration of type 2 diabetes and liver-related events in nonalcoholic fatty liver disease: A landmark analysis","volume":"78","author":"Zhang","year":"2023","journal-title":"J Hepatol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01655-5","article-title":"Type 2 diabetes","volume":"400","author":"Ahmad","year":"2022","journal-title":"J Lancet"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2021.05.013","article-title":"An update on the epidemiology of type 2 diabetes: A global perspective","volume":"50","author":"Tinajero","year":"2021","journal-title":"J Endocrinol Metab Clinics"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.12618","article-title":"Sugar-sweetened and artificially sweetened beverages and risk of liver cancer and chronic liver disease mortality","volume":"330","author":"Zhao","year":"2023","journal-title":"J JAMA"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3997","DOI":"10.3390\/nu15183997","article-title":"Sugar-sweetened beverages and artificially sweetened beverages consumption and the risk of nonalcoholic fatty liver (nafld) and nonalcoholic steatohepatitis (nash)","volume":"15","author":"Tseng","year":"2023","journal-title":"J Nutrients"},{"key":"B18","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.3350\/cmh.2022.0367","article-title":"Mafld: How is it different from nafld? J","volume":"29","author":"Gofton","year":"2022","journal-title":"Clin Mol hepatol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.1674-5809.2014.07.004","article-title":"China guideline for type 2 diabetes","volume":"6","author":"Society","year":"2014","journal-title":"J Chin J Diabetes Mellitus"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1999","DOI":"10.1053\/j.gastro.2019.11.312","article-title":"Mafld: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease","volume":"158","author":"Eslam","year":"2020","journal-title":"J Gastroenterol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"100323","DOI":"10.1016\/j.jhepr.2021.100323","article-title":"A dynamic association between myosteatosis and liver stiffness: Results from a prospective interventional study in obese patients","volume":"3","author":"Nachit","year":"2021","journal-title":"J JHEP Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"5888","DOI":"10.3390\/ijms21165888","article-title":"History of nonalcoholic fatty liver disease","volume":"21","author":"Lonardo","year":"2020","journal-title":"J Int J Mol Sci"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2020.04.001","article-title":"Looking into a new era for the approach of metabolic (dysfunction) associated fatty liver disease","volume":"19","author":"Valencia-Rodr\u00edguez","year":"2020","journal-title":"J Ann Hepatol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-023-02278-8","article-title":"Incident type 2 diabetes attributable to suboptimal diet in 184 countries","volume":"29","author":"O\u2019hearn","year":"2023","journal-title":"J Nat Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2024.05.006","article-title":"Increased hepatic gluconeogenesis and type 2 diabetes mellitus","volume":"35","author":"Barroso","year":"2024","journal-title":"J Trends Endocrinol Metab"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/advs.202300416","article-title":"Hepatic phospholipid remodeling modulates insulin sensitivity and systemic metabolism","volume":"10","author":"Tian","year":"2023","journal-title":"J Adv Sci (Weinh)"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15946","article-title":"Associations of dietary sugars with liver stiffness in latino adolescents with obesity differ on pnpla3 and liver disease severity","volume":"44","author":"Schenker","year":"2024","journal-title":"J Liver Int"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1038\/s12276-020-00509-3","article-title":"Set8 suppression mediates high glucose-induced vascular endothelial inflammation via the upregulation of pten","volume":"52","author":"Shen","year":"2020","journal-title":"J\u00a0Exp Mol Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/med.21970","article-title":"Molecular mechanisms and therapeutic perspectives of peroxisome proliferator-activated receptor alpha agonists in cardiovascular health and disease","volume":"43","author":"Pu","year":"2023","journal-title":"J Med Res Rev"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1111\/dom.16450","article-title":"Mechanisms of vascular endothelial cell injury triggered by blood glucose changes in gestational diabetes mellitus","volume":"27","author":"Cai","year":"2025","journal-title":"J Diabetes Obes Metab"},{"key":"B31","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1186\/s12933-025-02683-y","article-title":"Evaluation of glycemic status and subclinical atherosclerosis in familial hypercholesterolemia subjects with or without ldl receptor mutation","volume":"24","author":"Di Giacomo Barbagallo","year":"2025","journal-title":"J Cardiovasc Diabetol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"9027","DOI":"10.1038\/s41467-024-53267-5","article-title":"Glucose metabolism controls monocyte homeostasis and migration but has no impact on atherosclerosis development in mice","volume":"15","author":"Gallerand","year":"2024","journal-title":"J Nat Commun"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1111\/liv.16005","article-title":"Acute hyperbilirubinemia determines an early subclinical renal damage: Evaluation of tubular biomarkers in cholemic nephropathy","volume":"44","author":"Scilletta","year":"2024","journal-title":"J Liver Int"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.lfs.2022.120999","article-title":"Dulaglutide mitigates high dietary fructose-induced renal fibrosis in rats through suppressing epithelial-mesenchymal transition mediated by gsk-3beta\/tgf-beta1\/smad3 signaling pathways","volume":"309","author":"Mohamad","year":"2022","journal-title":"J Life Sci"},{"key":"B35","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.jhep.2021.02.027","article-title":"Fructose- and sucrose- but not glucose-sweetened beverages promote hepatic de novo lipogenesis: A randomized controlled trial","volume":"75","author":"Geidl-Flueck","year":"2021","journal-title":"J J Hepatol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2023.155591","article-title":"Fructose induced khk-c can increase er stress independent of its effect on lipogenesis to drive liver disease in diet-induced and genetic models of nafld","volume":"145","author":"Park","year":"2023","journal-title":"J Metab"},{"key":"B37","doi-asserted-by":"publisher","first-page":"4588","DOI":"10.3390\/nu15214588","article-title":"Associations of combined lifestyle factors with mafld and the specific subtypes in middle-aged and elderly adults: The dongfeng-tongji cohort study","volume":"15","author":"Li","year":"2023","journal-title":"J Nutrients"},{"key":"B38","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1159\/000443344","article-title":"Easl-easd-easo clinical practice guidelines for the management of non-alcoholic fatty liver disease","volume":"9","year":"2016","journal-title":"J Obes facts"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.freeradbiomed.2025.07.053","article-title":"Soybean genistin-driven gut microbiota-derived butyrate synthesis activates the sirt1 signaling pathway to ameliorate metabolic fatty liver","volume":"239","author":"Yi","year":"2025","journal-title":"J Free Radic Biol Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2022.114005","article-title":"Induction of autophagy via the pi3k\/akt\/mtor signaling pathway by pueraria flavonoids improves non-alcoholic fatty liver disease in obese mice","volume":"157","author":"Sun","year":"2023","journal-title":"J BioMed Pharmacother"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1651370\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T04:17:05Z","timestamp":1759292225000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1651370\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":40,"alternative-id":["10.3389\/fendo.2025.1651370"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1651370","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"article-number":"1651370"}}