Creatinine-to-body weight ratio as a marker of metabolic dysfunction and obesity-related steatosis in Egyptian patients

Background Metabolic dysfunction-associated fatty liver disease (MASLD) is closely linked to obesity, altered body composition, and metabolic dysregulation. The creatinine-to-body weight (Cre/BW) ratio has been proposed as a simple surrogate measure of relative muscle mass and metabolic risk. This study aimed to evaluate the association between the Cre/BW ratio and metabolic dysfunction, HSI-defined steatosis, and hepatic indices, and to assess its diagnostic performance in non-elderly Egyptian patients. Methods This cross-sectional study included 190 non-elderly patients who underwent clinical, biochemical, and imaging assessments. The creatinine-to-body weight (Cre/BW) ratio was calculated and evaluated in relation to anthropometric measures, liver enzymes, Hepatic Steatosis Index (HSI), and fibroscan parameters. ROC analysis was performed using HSI ≥36 as a surrogate definition of metabolic steatosis. Results A lower creatinine-to-body weight ratio was significantly associated with higher HSI (r = −0.260, p < 0.001), BMI (r = −0.263, p < 0.001), and waist circumference (r = −0.225, p = 0.002). The ratio showed stronger associations with metabolic and obesity-related parameters than with imaging-based measures of hepatic steatosis or fibrosis severity. Conclusion A low creatinine-to-body weight ratio was associated with metabolic dysfunction and HSI-defined steatosis in non-elderly Egyptian patients. However, this association was not independently maintained after adjustment for BMI and other metabolic factors, suggesting that the Cre/BW ratio may primarily reflect body composition and obesity-related metabolic abnormalities rather than serving as an independent marker of hepatic steatosis.