The impact of general health on MASLD progression, revealing associations with steatosis and fibrosis through structural equation modeling

To investigate the association between psychological well-being, assessed using the General Health Questionnaire-28 (GHQ-28), and hepatic steatosis and fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), and to examine the direct and indirect effects of demographic and lifestyle factors using structural equation modeling. A total of 406 patients with MASLD were included (51.2% men; mean age, 45.8 ± 12.2 years). The mean GHQ-28, liver stiffness measurement, and controlled attenuation parameter values were 43.48 ± 8.84, 8.30 ± 3.82 kPa, and 292.80 ± 51.43 dB/m, respectively. Overall, 63.5% of participants had moderate psychological impairment. The GHQ-28 score was significantly associated with steatosis (standardized β = 0.245, P = 0.012), but not fibrosis. BMI showed significant direct effects on steatosis (β = 0.322, P < 0.001) and fibrosis (β = 0.293, P = 0.001), as well as an indirect association with steatosis through GHQ-28. Physical activity was associated with lower steatosis, whereas smoking was associated with poorer psychological health. These findings suggest a complex association between psychological well-being, lifestyle factors, and hepatic steatosis in MASLD, while the relationship with fibrosis remains less clear.