Background and aims: The prevalence of metabolic dysfunction‐associated steatotic liver disease (MASLD) has increased during the epidemic of obesity. Type 2 diabetes mellitus (T2DM) is associated with progressive MASLD. Therefore, many guidelines recommend screening for MASLD in patients with T2DM. Most studies in patients with MASLD have been conducted in specialist care. We investigated the prevalence and severity of MASLD in patients with T2DM from primary care. Methods: Patients with T2DM were prospectively included from primary care facilities to undergo transient elastography with controlled attenuation parameter and whole‐body magnetic resonance imaging (MRI) to assess liver fat, cardiac function, muscle composition, and distribution of body fat. Results: Among 308 participants, 59% had MASLD, 7% had suspected advanced fibrosis (transient elastography ≥ 10 kPa), and 1.9% had cirrhosis. The mean age was 63.9 ± 8.1 years; 37% were female, with no differences between the MASLD and the non‐MASLD groups. Participants with MASLD had greater body mass index (31.1 ± 4.4 vs. 27.4 ± 4.1 kg/m ² , p  < 0.001) and a higher prevalence of obesity (60% vs. 21%, p < 0.001). Obesity increased the risk of fibrotic MASLD eightfold, as confirmed by multivariable analysis. Participants with MASLD also had increased visceral and abdominal subcutaneous adipose tissue and muscle fat infiltration. On cardiac MRI, participants with MASLD had a lower left ventricular (LV) stroke volume index, a lower LV end‐diastolic volume index, and an increased LV concentricity. Conclusions: In this cohort of primary care patients with T2DM, 59% had MASLD, and 7% had suspected advanced fibrosis. Obesity was a strong predictor of fibrotic MASLD. MASLD was associated with alterations to the left ventricle and increased deposition of ectopic fat.

Objectives To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age. Methods This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines. Results The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness. Conclusion This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.

Background: Non-alcoholic fatty liver disease (NAFLD) affects 20–30% of the general adult population. NAFLD patients with type 2 diabetes mellitus (T2DM) are at an increased risk of advanced fibrosis, which puts them at risk of cardiovascular complications, hepatocellular carcinoma, or liver failure. Liver biopsy is the gold standard for assessing hepatic fibrosis. However, its utility is inherently limited. Consequently, the prevalence and characteristics of T2DM patients with advanced fibrosis are unknown. Therefore, the purpose of the current study is to evaluate the prevalence and severity of NAFLD in patients with T2DM by recruiting participants from primary care, using the latest imaging modalities, to collect a cohort of well phenotyped patients.Methods: We will prospectively recruit 400 patients with T2DM using biomarkers to assess their status. Specifically, we will evaluate liver fat content using magnetic resonance imaging (MRI); hepatic fibrosis using MR elastography and vibration-controlled transient elastography; muscle composition and body fat distribution using water-fat separated whole body MRI; and cardiac function, structure, and tissue characteristics, using cardiovascular MRI.Discussion: We expect that the study will uncover potential mechanisms of advanced hepatic fibrosis in NAFLD and T2DM and equip the clinician with better diagnostic tools for the care of T2DM patients with NAFLD.Trial registration:Clinicaltrials.gov, identifier NCT03864510. Registered 6 March 2019,https://clinicaltrials.gov/ct2/show/NCT03864510.