Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
Healthy Lifestyle and the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease: A Large Prospective Cohort Study: Qing Chang, Yixiao Zhang, Tingjing Zhang, Zuyun Liu, Limin Cao, Qing Zhang, Li Liu, Shaomei Sun, Xing Wang, Ming Zhou, Qiyu Jia, Kun Song, Yang Ding, Yuhong Zhao, Kaijun Niu, Yang Xia; Diabetes Metab J. 2024;48(5):971-982. Published online March 19, 2024; DOI: https://doi.org/10.4093/dmj.2023.0133

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Background
The incidence density of metabolic dysfunction-associated fatty liver disease (MAFLD) and the effect of a healthy lifestyle on the risk of MAFLD remain unknown. We evaluated the prevalence and incidence density of MAFLD and investigated the association between healthy lifestyle and the risk of MAFLD.
Methods
A cross-sectional analysis was conducted on 37,422 participants to explore the prevalence of MAFLD. A cohort analysis of 18,964 individuals was conducted to identify the incidence of MAFLD, as well as the association between healthy lifestyle and MAFLD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) with adjustments for confounding factors.
Results
The prevalence of MAFLD, non-alcoholic fatty liver disease, and their comorbidities were 30.38%, 28.09%, and 26.13%, respectively. After approximately 70 thousand person-years of follow-up, the incidence densities of the three conditions were 61.03, 55.49, and 51.64 per 1,000 person-years, respectively. Adherence to an overall healthy lifestyle was associated with a 19% decreased risk of MAFLD (HR, 0.81; 95% CI, 0.72 to 0.92), and the effects were modified by baseline age, sex, and body mass index (BMI). Subgroup analyses revealed that younger participants, men, and those with a lower BMI experienced more significant beneficial effects from healthy lifestyle.
Conclusion
Our results highlight the beneficial effect of adherence to a healthy lifestyle on the prevention of MAFLD. Health management for improving dietary intake, physical activity, and smoking and drinking habits are critical to improving MAFLD.

Citations

Citations to this article as recorded by

The Role of Kupffer Cells and Liver Macrophages in the Pathogenesis of Metabolic Dysfunction-Associated Steatotic Liver Disease
Ioannis Tsomidis, Angeliki Tsakou, Argyro Voumvouraki, Elias Kouroumalis
Biomedicines.2026; 14(1): 151. CrossRef
Impact of healthy lifestyles on the risk of metabolic dysfunction‐associated steatotic liver disease among adults with comorbid hypertension and diabetes: Novel insight from a largely middle‐aged and elderly cohort in South China
Jun‐Yan Xi, Yi‐Jing Wang, Xiao‐Heng Li, Nuo‐Min Sun, Rui‐Qi Ming, Hua‐Ling Yan, Huan‐Le Cai, Jian‐Jun Bai, Yi‐Ning Xiang, Jing Gu, Xiao Lin, Gang Liu, Yuan‐Tao Hao
Diabetes, Obesity and Metabolism.2025; 27(5): 2800. CrossRef
Cholesteryl ester transfer protein gene variants and metabolic dysfunction-associated steatotic liver disease: genetic associations with steatosis in obese and lean individuals
Asmaa AbdelFattah, Mahmoud Kattab, Hosny Abdel Ghany, Lamiaa Aly, Ahmed Mady, Aly Hamdi, Riham Soliman, Gamal Shiha, Nada El-Domiaty
Egyptian Liver Journal.2025;[Epub] CrossRef
Research trends on the quality of life in patients with metabolic dysfunction-associated fatty liver diseases: a scientific metrology study
Can Huang, Meng Chen, Yanfang Sun, Lin Zhang, Wei Liu
Frontiers in Nutrition.2025;[Epub] CrossRef
The relationship between tobacco and non-alcoholic fatty liver disease incidence: a systematic review and meta-analysis of observational studies
Jianxiang Jin, Yuping Zhang, Yiping Huang
Frontiers in Medicine.2025;[Epub] CrossRef
Enhancing MAFLD Care: Efficacy of a Multidisciplinary Community Intervention on Self-Management and Hepatic Outcomes
Huan-Jing Cai, Hai-Lun Liang, Lei-Yu Shi, Yi-Hui Rong, Jing Li, Yan Zhang, Rui-Fang Ma
INQUIRY: The Journal of Health Care Organization, Provision, and Financing.2025;[Epub] CrossRef
Mechanistic investigation of DDT/DDE in MASLD/MASH pathogenesis: An integrated network toxicology and transcriptomics approach
Yicheng Jiang, Yuancheng Shao, Jiaming Xue, Zhigang Chen, Qi Liu, Shuai Chen, Xihan Gu, Shufan Zhang, Liming Tang
Ecotoxicology and Environmental Safety.2025; 307: 119390. CrossRef
Multiorgan crosstalk in MASLD/MASH: from hepatic pathogenesis to systemic complications
Wenhua Bai, Zheng Zhu
Frontiers in Endocrinology.2025;[Epub] CrossRef
Diagnostic indicators and lifestyle interventions of metabolic-associated fatty liver disease
Tianzhu Chen, Xiang Qin, Jianping Jiang, Beihui He
Frontiers in Nutrition.2024;[Epub] CrossRef
Sex differences in pathogenesis and treatment of dyslipidemia in patients with type 2 diabetes and steatotic liver disease
Tatjana Ábel, Béla Benczúr, Éva Csajbókné Csobod
Frontiers in Medicine.2024;[Epub] CrossRef
Associations of traditional healthy lifestyle and sleep quality with metabolic dysfunction-associated fatty liver disease: two population-based studies
Jialu Yang, Qi Zhang, Wanying Zhao, Bingqi Ye, Siqi Li, Zhuoyu Zhang, Jingmeng Ju, Jialin He, Min Xia, Tiantian Xiong, Yan Liu
Nutrition & Diabetes.2024;[Epub] CrossRef

Basic Research
Supplementation of Clostridium butyricum Alleviates Vascular Inflammation in Diabetic Mice: Tian Zhou, Shuo Qiu, Liang Zhang, Yangni Li, Jing Zhang, Donghua Shen, Ping Zhao, Lijun Yuan, Lianbi Zhao, Yunyou Duan, Changyang Xing; Diabetes Metab J. 2024;48(3):390-404. Published online February 2, 2024; DOI: https://doi.org/10.4093/dmj.2023.0109

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Background
Gut microbiota is closely related to the occurrence and development of diabetes and affects the prognosis of diabetic complications, and the underlying mechanisms are only partially understood. We aimed to explore the possible link between the gut microbiota and vascular inflammation of diabetic mice.
Methods
The db/db diabetic and wild-type (WT) mice were used in this study. We profiled gut microbiota and examined the and vascular function in both db/db group and WT group. Gut microbiota was analyzed by 16s rRNA sequencing. Vascular function was examined by ultrasonographic hemodynamics and histological staining. Clostridium butyricum (CB) was orally administered to diabetic mice by intragastric gavage every 2 days for 2 consecutive months. Reactive oxygen species (ROS) and expression of nuclear factor erythroid-derived 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) were detected by fluorescence microscopy. The mRNA expression of inflammatory cytokines was tested by quantitative polymerase chain reaction.
Results
Compared with WT mice, CB abundance was significantly decreased in the gut of db/db mice, together with compromised vascular function and activated inflammation in the arterial tissue. Meanwhile, ROS in the vascular tissue of db/db mice was also significantly increased. Oral administration of CB restored the protective microbiota, and protected the vascular function in the db/db mice via activating the Nrf2/HO-1 pathway.
Conclusion
This study identified the potential link between decreased CB abundance in gut microbiota and vascular inflammation in diabetes. Therapeutic delivery of CB by gut transplantation alleviates the vascular lesions of diabetes mellitus by activating the Nrf2/HO-1 pathway.

Citations

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Flavonoids and Their Influence on the Gut Microbiome: Implications for Cardiovascular Health
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Gut Microbiota and Their Metabolites as Modulators of Vascular Complications in Diabetes
Meng Duan, Jielu Wen, Anning Chen, Sifan Chen
Health and Metabolism.2025; : 2. CrossRef
Systematic Review of the Effectiveness of Common Probiotic Strains: Streptococcus faecalis, Clostridium butyricum, Bacillus mesentericus, and Lactobacillus sporogenes in the Management of Diabetes
Basavaraj G. Sooragonda, Preyander Thakur, Rajesh Moganti, Arpit Garg, Umesh Kumar Garg
Journal of Diabetology.2025; 16(1): 29. CrossRef
Antibodies against Clostridium butyricum in the children of mothers at risk for gestational diabetes
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Immunological Medicine.2025; 48(4): 346. CrossRef
The Protective Effects of Lactobacillus reuteri Combined With Clostridium butyricum Miyairi 588 on Intestinal Barrier Function, Water Transport, and Oxidative Stress in a Rat Model of 5FU‐Induced Diarrhea
Sheau‐Chung Tang, Wen‐Chen Chuang, Jiuan‐Miaw Liao, Yi‐Hsuan Tsai, Liang‐Chuan Chen, Jiunn‐Wang Liao, Jiunn‐Liang Ko, Chu‐Chyn Ou
Food Science & Nutrition.2025;[Epub] CrossRef
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Chao Yin, Peizhi Fan, Xiangyu Mou, Wenjing Zhao
Microorganisms.2025; 13(6): 1220. CrossRef
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Jingjing Xu, Yuhao Zhang, Jingyu Liao, Wanqi Le, Gaosong Wu, Weidong Zhang
Phytotherapy Research.2025; 39(7): 3323. CrossRef
Interaction Between Microbiota and Immunity: Molecular Mechanisms, Biological Functions, Diseases, and New Therapeutic Opportunities
Jingjing Zeng, Zimeng He, Guoqing Wang, Yuxin Ma, Feng Zhang
MedComm.2025;[Epub] CrossRef
Clostridium butyricum Promotes Bone Remodeling by Activating Inflammatory Genes in Mice
Yanxin Jia, Longfei Xu, Zijing Ju, Mengze Song, Yonghao Zhou, Bin Li, Fang Wang, Hai Lin, Shuhong Sun, Haifang Li
Probiotics and Antimicrobial Proteins.2025;[Epub] CrossRef
Role of intestinal SCFAs homeostasis in the hepatoprotective effect of Clostridium butyricum in T2DM
Meng Yan, Dandan Pan, Libang Chen, Jiale Pang, Yuting Shao, Qian Cheng, Ying Liu, Zeyuan Yin, Zhenzhou Jiang, Pian Sha, Yuqian Huang, Yilin Fan, Sitong Qian, Tao Wang, Qian Lu, Tingting Yang
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Herbal Combination of Angelica gigas, Zingiber officinale, and Aconitum carmichaeli Alleviates High Fat Diet‐Induced Non‐Alcoholic Fatty Liver Disease in Mice Through NRF2‐Mediated Regulation of Adipogenesis and Non‐Shivering Thermogenesis
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