Before treatment alters the picture: ultrasound and metabolic biomarkers in treatment-naïve MASLD-the modifying role of BMI.

OBJECTIVE

B-mode ultrasonography is widely used to assess hepatic steatosis in MASLD. The associations between ultrasound-assessed steatosis, liver size, and metabolic abnormalities have previously been studied without considering whether the patients had received treatment. Medications may modify liver enzymes, glycemic indices, lipid profiles, and body weight and may strongly affect these relationships. Therefore, we aimed to evaluate hepatic echogenicity grade and liver size in relation to body mass index (BMI) and metabolic markers in newly diagnosed, treatment-naïve MASLD patients.

MATERIALS AND

METHODS

In this cross-sectional study, 122 adults with MASLD, as confirmed by a gastroenterologist, were enrolled. Hepatic echogenicity and cranio-caudal liver length were assessed using B-mode ultrasonography. Metabolic parameters, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol, triglycerides (TG), total bilirubin, and glycated hemoglobin (HbA1c), were analyzed. Kruskal-Wallis and Mann-Whitney U tests were used for group comparisons, while Spearman's correlation and regression models were used to assess associations, including the modifying effect of BMI.

RESULTS

In unadjusted group comparisons, ALT, AST, and HbA1c differed across steatosis grades after Benjamini-Hochberg correction, whereas total cholesterol and triglycerides showed no consistent pattern. Hepatomegaly was associated with higher BMI, ALT, AST, and HbA1c. In adjusted models, grade×BMI interactions were negative for ALT and AST (both P < 0.001), whereas the adjusted grade association between steatosis grade and HbA1c was not significant (P = 0.324). After adjustment for BMI, steatosis grade, age, and sex, liver length remained associated with ALT (β = 0.073, 95% CI 0.046 to 0.100) and AST (β = 0.062, 95% CI 0.033 to 0.092).

CONCLUSION

In treatment-naïve adults with MASLD, ultrasound-assessed steatosis grade and liver size were associated with selected metabolic and biochemical measures. Negative grade×BMI interactions were observed for ALT and AST, while the adjusted association between steatosis grade and HbA1c was not significant. These findings should be interpreted cautiously in the context of the study's design.