Olubamwo OO, et al. - Via a prospective epidemiological study of 1,792 Finnish men without diabetes at baseline, the experts analyzed whether metabolic syndrome (MS) status influenced the correlation of fatty liver disease (FLD, the most common cause of chronic liver disease globally) with incident type 2 diabetes (T2D) in middle-aged men. Three hundred and seventy-five incident cases of T2D were enrolled, during a mean follow-up of 19 years. Fatty liver index (FLI) could only predict T2D among persons without MS. In comparison with persons with FLI <30 without MS, individuals with FLI ≥60 without MS had an elevated risk for T2D. Moreover, people with FLI <30 and MS and persons with both FLI ≥60 and MS had a higher risk. Usually, T2D (FLI ≥60) was predicted by FLD. Among men without MS, FLD mainly prognosticated T2D but not among men with MS, for whom MS alone previously enhanced the risk. Furthermore, in screening and surveillance for individuals with increased T2D risk, both FLI and MS could support each other.