MASLD and Cognitive Impairment Correlate with Diabetic Management

Noriko Satoh-AsaharaJapan Speaker MASLD and Cognitive Impairment Correlate with Diabetic ManagementIn recent years, the coexistence of metabolic dysfunction–associated steatotic liver disease (MASLD) and cognitive decline in patients with diabetes has attracted growing attention. These conditions are not merely concurrent comorbidities but share common pathophysiological mechanisms involving insulin resistance, chronic inflammation, and gut dysbiosis. Using a large health checkup database, we reported that a body weight gain of more than 10 kg since the age of 20 is a significant risk factor for the development of MASLD (Nutrients, 2025). Moreover, we found that subsequent weight reduction markedly attenuated this risk, emphasizing the importance of appropriate weight management. In our multicenter diabetic cohort studies of the National Hospital Organization (JOMS/J-DOS2), we reported that circulating soluble TREM2 (sTREM2) —a receptor specifically expressed in monocytes and microglia—was significantly associated with cognitive decline in patients with diabetes, suggesting its potential as a predictive biomarker for dementia (Diabetes Metab, 2019; Front Endocrinol, 2022). Furthermore, our network meta-analysis in patients with type 2 diabetes revealed that SGLT2 inhibitors, GLP-1 receptor agonists, and thiazolidinediones may reduce the risk of cognitive impairment (Diabetes Obes Metab, 2025). Novel antidiabetic agents, particularly GLP-1 receptor agonists, have been shown to improve hepatic function and preserve cognitive performance. Collectively, these findings suggest that optimized diabetic management may hold the key to preventing both MASLD and dementia. In this presentation, I would like to summarize recent evidence and discuss optimal therapeutic strategies for MASLD and cognitive impairment in patients with diabetes.