Ultrasound-derived visceral adipose tissue as a reliable marker of hepato-metabolic risk in patients with MASLD

There is increasing evidence that visceral adipose tissue (VAT) plays a key role in the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD), yet its clinical assessment remains limited by the need for advanced imaging. In this cross-sectional study of 747 patients at metabolic risk, we evaluated whether ultrasound (US)-measured VAT is more strongly associated with hepatic steatosis and metabolic dysfunction than conventional anthropometric indices. Hepatic fat was quantified via ultrasound-derived fat fraction (UDFF), while liver stiffness and FibroScan-AST (FAST) score assessed disease severity. Stratification by VAT tertiles showed a progressive increase in UDFF and the prevalence of diabetes, hypertension, and dyslipidaemia. VAT correlated more strongly than body mass index (BMI) and waist circumference (WC) with triglycerides and UDFF (p < 0.05), and was more strongly associated with HbA1c, ALT and FAST than BMI. In standardized multivariate analysis, VAT remained independently associated with UDFF (beta= 2.49, p < 0.001). Associations of VAT with UDFF and metabolic parameters were stronger in women than in men. These findings support the use of US-derived VAT as a non-invasive and low-cost biomarker to improve risk stratification beyond BMI and WC, serving as a practical tool to monitor response to therapies targeting visceral fat, in MASLD management.