Association between visceral adiposity index and metabolic dysfunction-associated steatotic liver disease in adults with type 1 diabetes mellitus an exploratory cross-sectional study

Purpose The visceral adiposity index (VAI), a sex-specific surrogate marker of visceral adipose tissue dysfunction and insulin resistance, has been proposed to identify metabolic dysfunction-associated steatotic liver disease (MASLD) in both the general population and individuals with type 2 diabetes. However, its association with MASLD in adults with type 1 diabetes mellitus (T1DM) remains unknown. Methods We consecutively enrolled 212 adults with T1DM who underwent vibration-controlled transient elastography for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) assessment. MASLD was defined as CAP ≥ 248 dB/m with at least one cardiometabolic risk factor. VAI was calculated using sex-specific formulas that included waist circumference, body mass index, triglycerides, and high-density lipoprotein cholesterol. Results MASLD was present in 62 (29.3%) participants, and significant fibrosis (LSM ≥ 8 kPa) was detected in 9 (4.3%) participants. Higher VAI values were significantly associated with MASLD (unadjusted odds ratio [OR] 1.87, 95% confidence interval [CI] 1.36–2.58; p < 0.001). This association remained significant after adjustment for study center, age, diabetes duration, hemoglobin A1c, and hypertension (adjusted OR 1.84, 95%CI 1.27–2.66; p = 0.001). However, waist circumference demonstrated better discriminatory performance in identifying MASLD than VAI (AUC 0.834, 95%CI 0.772–0.896 vs. AUC 0.708, 95%CI 0.631–0.785; p = 0.006 by DeLong test), whereas BMI showed comparable discriminatory performance. Conclusions Higher VAI values are associated with MASLD in patients with T1DM. However, waist circumference outperforms VAI in identifying MASLD, suggesting that VAI may serve as a complementary marker of metabolic dysfunction rather than a standalone screening tool for MASLD in this patient population.