{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:30:26Z","timestamp":1772602226507,"version":"3.50.1"},"reference-count":50,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"HEAL ITALIA\u2014Health Extended Alliance for Innovative Therapies, Advanced Lab-research and Integrated Approaches of Precision Medicine","award":["PE_00000019"],"award-info":[{"award-number":["PE_00000019"]}]},{"name":"European Union\u2014NextGenerationUE as part of PNRR MUR\u2014M4C2\u2014Investimento 1.3\u2014Public Call \u201cPartenariati Estesi\u201d\u2014D.D.","award":["341\/2022"],"award-info":[{"award-number":["341\/2022"]}]},{"name":"Dept. of Medical and Surgical Sciences of the University of Foggia"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Background: Malnutrition is a prevalent and under-recognized condition in patients with type 2 diabetes mellitus (T2DM), contributing to various complications, including liver fibrosis. In this study, we aimed to evaluate the association between malnutrition and liver fibrosis in patients with T2DM, and to assess whether inflammation mediates this relationship. Methods: In this prospective single-centre study, 87 adult outpatients with T2DM underwent nutritional assessment using the Subjective Global Assessment (SGA) and liver stiffness measurement by transient elastography. Metabolic dysfunction-associated steatotic liver disease (MASLD) was diagnosed according to EASL guidelines. C-reactive protein (CRP) was measured as a marker of systemic inflammation. Multivariable linear regression and mediation analysis were performed, adjusting for age and sex. Results: Malnutrition was present in 50.6% of patients, MASLD in 66.7%, and both conditions coexisted in 36.8%. Malnutrition (B = 2.29, p &lt; 0.001), MASLD (B = 1.54, p = 0.001), smoking (B = 1.06, p = 0.014), and CRP (B = 0.32, p &lt; 0.001) were independently associated with increased liver stiffness. CRP partially mediated the effect of malnutrition on liver stiffness (indirect effect = 0.54; 95% CI 0.20\u20130.95), accounting for 18% of the total effect. Conclusions: In T2DM, malnutrition is a strong independent predictor of liver fibrosis, with its effect partially mediated by systemic inflammation. Addressing nutritional status and inflammatory burden may help slow fibrotic progression in this high-risk population.<\/jats:p>","DOI":"10.3390\/biom15121735","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:11:23Z","timestamp":1765793483000},"page":"1735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Malnutrition Is Associated with Increased Liver Stiffness in Type 2 Diabetes: The Mediating Role of Inflammation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1569-3658","authenticated-orcid":false,"given":"Aurelio","family":"Lo Buglio","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8196-7373","authenticated-orcid":false,"given":"Francesco","family":"Bellanti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9875-019X","authenticated-orcid":false,"given":"Rosanna","family":"Villani","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1152-3371","authenticated-orcid":false,"given":"Cristiano","family":"Capurso","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grazia Pia","family":"Magnati","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Cioffi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriele","family":"Tedesco","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo Alberto","family":"Torsello","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7951-0219","authenticated-orcid":false,"given":"Gianluigi","family":"Vendemiale","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6424-7841","authenticated-orcid":false,"given":"Gaetano","family":"Serviddio","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e13610","DOI":"10.1111\/1753-0407.13610","article-title":"Prevalence and Influencing Factors of Malnutrition in Diabetic Patients: A Systematic Review and Meta-analysis","volume":"16","author":"Zhang","year":"2024","journal-title":"J. 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