Preperitoneal fat thickness as a potential noninvasive marker for metabolic-associated liver disease: A retrospective study

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is steadily increasing and visceral adiposity plays a pivotal role in its development. The maximum preperitoneal fat thickness (PMFT) and abdominal fat index (AFI), when measured via ultrasound, are practical, cost-effective, and reliable indices that best estimate visceral fat area, as measured by CT. This study aimed to explore the relationship between MASLD and PMFT by using ultrasound, a noninvasive and dependable diagnostic modality. This retrospective study used data from patients consecutively evaluated for MASLD at the Hepatology Clinic of Dr Abdurrahman Yurtaslan Hospital between July and December 2024. PMFT, AFI, and minimum subcutaneous fat thickness (SMFT) values were compared between patients with and without a diagnosis of MASLD. As the PMFT and AFI parameters are interrelated variables, they were analyzed using 2 separate regression models. Independent variables considered risk factors for MASLD (age, sex, exercise, PMFT, and AFI) were included in the binary logistic regression analysis. Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC) values for PMFT, AFI, and SMFT to evaluate their ability to distinguish between MASLD and non-MASLD cases. This study included 130 patients, 71 diagnosed with MASLD and 59 without MASLD. In the regression analysis, MASLD was positively associated with PMFT (odds ratio [OR] = 33.626, 95% confidence interval [CI]: 11.498-98.338, P < .001) after adjusting for confounding and clinical variables. Furthermore, AFI was independently associated with MASLD (OR = 3.492, 95% CI: 1.418-8.599, P < .001). PMFT values showed significant diagnostic accuracy in distinguishing MASLD from non-MASLD (AUC, P < .001) with an optimal cutoff of > 15.9 mm. Similarly, AFI values were significant (AUC, P < .01) with the best cutoff of > 1.18. In contrast, the SMFT values did not demonstrate significant diagnostic accuracy (AUC, P > .05). PMFT and AFI showed significant diagnostic value in distinguishing MASLD, with PMFT being the most strongly associated marker. These findings support their use as practical, noninvasive tools for early MASLD diagnosis and risk assessment, whereas the SMFT lacks diagnostic relevance.