World Journal of Diabetes - Letter to the Editor - Zhejiang University index predicts metabolic dysfunction-associated steatotic liver disease in type 2 diabetes mellitus patients

Sep 28, 2026

Zhejiang University (ZJU) index integrates BMI, fasting blood glucose, triglycerides, and the ALT/AST ratio to predict metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM). A ZJU index of 38.87 serves as the key diagnostic threshold, and a ZJU-based prediction model demonstrates high diagnostic value. The correspondence highlights cross-sectional and inpatient-cohort limitations, insufficient pharmacotherapy adjustment, and ultrasound-based diagnostic reliance, calling for outpatient and future prospective validation with medication and advanced fibrosis assessment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

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Abstract

Core Tip

Citation

Key Findings and Limitations

| W | J | D | World Journal of
Diabetes | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Diabetes 2025 December 15; 16(12): 114565 DOI: 10.4239/wjd.v16.i12.114565 ISSN 1948-9358 (online) LETTER TO THE EDITOR Zhejiang University index predicts metabolic dysfunction-associated steatotic liver disease in type 2 diabetes mellitus patients Man Zhang, Miao-Guang Yu, Xiang-Nan Shen, Guo-Bin Kang Specialty type: Endocrinology and metabolism Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B, Grade B, Grade B, Grade B Novelty: Grade B, Grade B, Grade B, Grade C Creativity or Innovation: Grade B, Grade B, Grade B, Grade C Scientific Significance: Grade B, Grade B, Grade B, Grade C P-Reviewer: Deng ZT, PhD, Postdoc, Associate Chief Physician, China; Zhang WY, MD, PhD, Assistant Professor, China Received: September 26, 2025 Revised: October 30, 2025 Accepted: November 12, 2025 Published online: December 15, 2025 Processing time: 81 Days and 3.5 Hours Man Zhang, Guo-Bin Kang, Department of Cardiology I, Hebei Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang 050000, Hebei Province, China Miao-Guang Yu, Department of Acupuncture and Moxibustion, Tianjin Ninghe District Hospital of Traditional Chinese Medicine, Tianjin 301509, China Xiang-Nan Shen, Department of Orthopedics II, Hebei Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang 050000, Hebei Province, China Corresponding author: Guo-Bin Kang, Academic Fellow, Department of Cardiology I, Hebei Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, No. 389 Zhongshan East Road, Shijiazhuang 050000, Hebei, China. [kanggb1229@126.com](kanggb1229@126.com) Abstract The Zhejiang University (ZJU) index, which combines body mass index, fasting blood glucose, triglyceride level and alanine aminotransferase/aspartate aminotransferase ratio, can be used to predict metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM) . The ZJU index of 38.87 has been identified as the key threshold for diagnosing MASLD. The new model for predicting MASLD in T2DM based on ZJU index shows high diagnostic value. While the study is methodologically robust and offers a valuable clinical tool, it is limited by its cross-sectional design, inpatient cohort bias, unadjusted pharmacotherapy effects, and reliance on ultrasound for MASLD diagnosis. Future validation in outpatient settings, incorporating medication data and advanced fibrosis assessment, is crucial to translate this cost-effective biomarker into wide practice. Key Words: Zhejiang University index; Metabolic dysfunction-associated steatotic liver disease; Type 2 diabetes mellitus; Predictive biomarker; Cross-sectional study; Pharmacotherapy confounding ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. WJD [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 15, 2025 Volume 16 Issue 12 Zhang M et al. ZJU index predict MASLD in T2DM Core Tip: This correspondence critically evaluates the study by Tao et al on the ability of the Zhejiang University index to predict metabolic dysfunction-associated steatotic liver disease (MASLD) in type 2 diabetes mellitus patients. It commends the index as it is a minimally invasive biomarker panel and methodologically sound but highlights several limitations, such as the reliance on a hospitalized patient sample, lack of information on pharmacological treatments, the inherent constraints of ultrasound imaging, and the cross-sectional nature of the study. The authors suggest that

FAQs

What inputs does the Zhejiang University (ZJU) index use to predict MASLD in T2DM?

The ZJU index combines body mass index, fasting blood glucose, triglyceride level, and the ALT/AST ratio.

What is the reported threshold value of the ZJU index for MASLD diagnosis?

A ZJU index of 38.87 is identified as the key threshold for diagnosing MASLD.

What limitations are emphasized regarding the current evidence?

The correspondence emphasizes cross-sectional design, inpatient cohort bias, limited adjustment for pharmacotherapy effects, and reliance on ultrasound for MASLD diagnosis.

Sep 28, 2026

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