Metabolic Dysfunction-Associated Steatotic Liver Disease Severity and Cardiovascular Outcomes in Type 2 Diabetes: A Scoping Review of Measures, Definitions, Phenotypes, and Associations

This scoping review will map the evidence on how metabolic dysfunction-associated steatotic liver disease (MASLD) severity and liver fibrosis are assessed and how they relate to cardiovascular outcomes in adults with type 2 diabetes mellitus (T2DM). Studies have used diverse non-invasive fibrosis scores, elastography methods and severity thresholds, alongside heterogeneous cardiovascular outcomes, making the evidence difficult to compare and synthesize. Following Joanna Briggs Institute scoping-review methodology and PRISMA-ScR guidance, the review will identify severity-assessment methods and definitions, catalogue cardiovascular phenotypes, summarize reported severity-specific associations and analytical approaches, and identify methodological gaps and priorities for future research. Eligible studies will be identified through systematic database searches and supplementary reference-list screening. Findings will be presented using descriptive tables, narrative synthesis and evidence maps rather than a predetermined pooled effect estimate. The review is expected to clarify the scope and consistency of evidence linking MASLD severity to cardiovascular outcomes in people with T2DM and inform future research on severity classification, cardiovascular risk assessment and longitudinal outcomes.