Two-Element Cesium-Zinc Plasma Contrast Across Ultrasound-Defined Hepatic Steatosis: An Exploratory Reanalysis of a Greek Adult Cohort

Background/Objectives Opposing plasma cesium and zinc gradients were previously reported across ultrasound-defined steatosis stages in this same Greek cohort. We evaluated whether these previously observed directions could be summarized as an outcome-informed, equal-weight two-element contrast associated with four-level steatosis. Methods The processed derivative contained 351 records; all ten elemental measurements were jointly available for 157 participants and absent for the remaining 194. Five of the 157 records contained an exact zero for cesium or zinc, leaving 152 participants in the positive-value primary analysis. The contrast was defined as z[ln(cesium)] - z[ln(zinc)] and evaluated using Spearman correlation and proportional-odds regression. Results Median contrast values increased across grades (-1.46, 0.11, 0.73, and 1.39; Spearman rho = 0.545, p < 0.001). Per interquartile-range increase, the age-, sex-, and BMI-adjusted ordinal odds ratio was 3.13 (95% CI 1.80-5.41; p < 0.001). Under protocol-based LOD/sqrt(2) replacement of the five residual zeros (n = 157), the pooled estimate attenuated to 1.73 (95% CI 1.11-2.69; p = 0.016) and the proportional-odds assumption was not supported (threshold-interaction p < 0.001). Conclusions The cesium-zinc contrast reformulates two previously reported element-steatosis gradients rather than constituting an independent elemental discovery. Its association is exploratory, sensitive to unresolved zero-value handling, and requires evaluation in an independent dataset with fully documented participant and analytical provenance.