High estradiol/testosterone ratio increased the risk of metabolic dysfunction-associated steatotic liver disease in men with type 2 diabetes mellitus.

Meng-Han Li, Jun-Wei Wang, Man-Rong Xu, Ya-Wen Zhang, Lian-Xi Li

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Observational study in Journal of diabetes investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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Meng-Han Li *Department of Endocrinology & Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China.ORCID https://orcid.org/0009-0002-6981-6078

Jun-Wei Wang *Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.

Man-Rong XuDepartment of Endocrinology & Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China.ORCID https://orcid.org/0000-0002-0519-1593

Ya-Wen ZhangDepartment of Endocrinology & Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China.

Lian-Xi LiDepartment of Endocrinology & Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China.ORCID https://orcid.org/0000-0001-6073-4901

Funding

National Natural Science Foundation of China 81770813National Natural Science Foundation of China 82070866

6 · The paper itself

Abstract

backgroundThe association between estradiol/testosterone (E2/T) ratio and metabolic dysfunction-associated steatotic liver disease (MASLD) remains controversial. Moreover, few studies have explored their relationship in men with type 2 diabetes mellitus. We aimed to investigate the association of the E2/T ratio with MASLD in type 2 diabetes mellitus male patients.

methodsThis real-world observational study was performed in 1441 male type 2 diabetes mellitus patients. MASLD was determined by abdominal ultrasonography. The clinical characteristics and prevalence of MASLD were compared across the E2/T ratio quartiles. The association of the E2/T ratio and quartiles with MASLD was also evaluated using binary logistic regression.

resultsAfter adjusting for age and diabetes duration (DD), MASLD prevalence significantly increased across the E2/T ratio quartiles (37.7%, 42.6%, 53.1%, and 69.3%, respectively, P < 0.001 for trend). Fully adjusted logistic regression showed that both the E2/T ratio (OR: 2.201, 95% CI: 1.380-3.511, P = 0.001) and quartiles (P = 0.001) were positively associated with MASLD in males with type 2 diabetes mellitus. Furthermore, C-reactive protein (CRP) levels were significantly higher in patients with MASLD compared with those without (P < 0.001), and obviously increased across the E2/T ratio quartiles after controlling for age and DD (P = 0.016 for trend).

conclusionsThe E2/T ratio was independently and positively associated with the increased risk of MASLD in male type 2 diabetes mellitus patients, which may be attributed to the close association between the E2/T ratio and inflammation. The E2/T ratio may serve as a simple and practical indicator to assess the risk of MASLD in male type 2 diabetes mellitus patients.

Indexed as

BiomarkersDiabetes Mellitus, Type 2EstradiolFatty LiverMetabolic DiseasesTestosteroneAgedHumansMaleMiddle AgedPrevalencePrognosisRisk FactorsBiomarkersEstradiolTestosteroneE2/T ratioMetabolic dysfunction‐associated steatotic liver diseaseType 2 diabetes mellitus

Identifiers

PMID41307227

DOI10.1111/jdi.70202

PMCPMC12757678

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