Vitamin D and the metabolic-associated steatotic liver disease-type 2 diabetes axis: a scoping-narrative review of global evidence and emerging perspectives for Sub-Saharan Africa
Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) and Type 2 Diabetes Mellitus (T2DM) are rapidly emerging as twin epidemics in Sub-Saharan Africa (SSA), driven by urbanization and nutritional transition. While global evidence links Vitamin D deficiency (VDD) to the progression of both disorders, data specific to African populations remains fragmented. This review explores the Vitamin D-MASLD-T2DM axis, contrasting global mechanistic insights with the unique genetic, environmental, and infectious disease landscape of SSA.
Methods: A hybrid scoping-narrative review was conducted searching PubMed/MEDLINE, Scopus, and Embase for literature published up to 2025. The search targeted mechanistic studies, clinical trials, and regional epidemiological data. Out of 948 initial citations, 59 high-quality studies were prioritized for synthesis. The review integrates molecular evidence of Vitamin D Receptor (VDR) signaling with clinical outcomes and evaluates their applicability to the African context.
Results: Mechanistic evidence indicates that Vitamin D exerts potent anti-inflammatory and insulin-sensitizing effects via VDR activation, specifically by downregulating hepatic de novo lipogenesis (SREBP-1c) and suppressing NF-κB signaling in Kupffer cells. Epidemiological data consistently associate VDD with increased liver fibrosis and insulin resistance. However, randomized controlled trials yield conflicting results, likely due to heterogeneity in dosing…
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