Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is affected by metabolic, psychological, and behavioral factors, with potential differences in pathophysiological pathways across racial groups. Objective This study aims to investigate the relationship between eating behaviors, emotional functioning, and anthropometric differences in Asian and maintain at various stages of liver disease. Methods A retrospective analysis was conducted on 98 MASLD patients (70 White and 28 Asian) from a Southern California liver clinic. Participants completed validated questionnaires assessing depressive and anxiety symptoms, eating behaviors, and quality of life. Body composition was measured using bioelectrical impedance analysis, and liver health was assessed through transient elastography. Multivariate regression and mediation analyses examined associations and pathways among psychological, behavioral, and clinical variables, with race as a moderator. Results White participants had higher body mass index (BMI) and body fat percentage, but liver steatosis and stiffness were similar between groups. In Asians, hepatic steatosis correlated most strongly with body fat mass, whereas in Whites, emotional eating was more closely linked to BMI and body fat percentage compared to Asians. Whites reported higher anxiety and lower quality of life. Emotional eating was associated with hepatic steatosis in both groups, but only in Whites did BMI and percent body fat mediate this relationship. Among Asians, emotional eating was linked to liver fat independent of body composition. Conclusion Distinct racial pathways exist in MASLD progression, with Asians potentially developing fatty liver without overt body fat changes. These findings highlight the need for tailored diagnostic and clinical strategies that consider metabolic, behavioral, and psychological differences across racial groups.
Scheneman et al. (Fri,) studied this question.