Multiparametric ultrasound and liver fibrosis Scores in adults with metabolic syndrome versus metabolically healthy controls

This study aimed to evaluate the applicability and discriminatory ability of four ultrasound-based techniques (2D-SWE, Vi.PLUS, Att.PLUS, SSp.PLUS) and four liver fibrosis scores (FIB-4, NFS, APRI, and BARD) for non-invasive evaluation of metabolic health status and obesity phenotypes in adults with metabolic syndrome versus metabolically healthy controls. In this cross-sectional study, adults were recruited from a health check-up program at Beijing Friendship Hospital between January 2024 and August 2025. All participants underwent ultrasonography using the Supersonic MACH ® 20 system to acquire 2D-SWE, Vi.PLUS, Att.PLUS, and SSp.PLUS measurements. Serum biomarkers were used to calculate FIB-4, NFS, APRI, and BARD scores. Metabolic health was defined as the absence of any metabolic syndrome components, and obesity was classified based on body mass index (BMI). A total of 610 participants (29% male, 49.3 ± 15.4 years) were included. After adjusting for confounding factors, higher BMI was independently associated with higher 2D-SWE (Beta: 0.128, 95% CI: 0.042–0.214, p = 0.004), higher Vi.PLUS (Beta: 1.783, 95% CI: 1.159–2.407, p < 0.001), higher Att.PLUS (Beta: 9.203, 95% CI: 6.634–11.771, p < 0.001), and lower SSp.PLUS (Beta: −0.031, 95% CI: −0.039-−0.022, p < 0.001). Multiple logistic regression analyses further revealed that elevated 2D-SWE (odds ratio [OR]: 1.288, 95% CI: 1.181–1.404; p < 0.001) and Vi.PLUS (OR: 6.673, 95% CI: 3.837–11.604; p < 0.001) were independently associated with metabolically unhealthy status. Additionally, participants with metabolically unhealthy obesity exhibited significantly higher 2D-SWE, Vi.PLUS, and Att.PLUS values, but significantly lower SSp.PLUS values. Furthermore, Vi.PLUS (AUC: 0.781, sensitivity: 73.3%, specificity :71.2%, p < 0.001) and 2D‑SWE (AUC: 0.773, sensitivity: 81.4%, specificity: 63.0%) both demonstrated good discriminatory ability for metabolically unhealthy status. This study demonstrates that multiparametric ultrasound techniques, particularly 2D‑SWE and Vi.PLUS, exhibit strong correlations with metabolic unhealthy status and BMI, and show promising predictive utility for metabolic risk stratification in metabolic syndrome populations. Not applicable. Not applicable.