Psychometric profiles and the phenotypic dissociation of imaging steatosis and elevated fibrosis risk in obesity.

OBJECTIVE

To evaluate the relationship between psychometric profiles and the phenotypic discordance of ultrasonography (USG)-detected steatosis and Fibrosis-4 (FIB-4) risk in obesity.

METHODS

This retrospective study included 206 patients with obesity (body mass index [BMI] ≥ 30 kg/m2). We categorized participants into concordant and discordant phenotypes based on USG findings and FIB-4 scores. Psychometric assessments included the Beck Depression Inventory, Eating Attitudes Test-40 (EAT-40), Body Cathexis Scale, and Emotional Eating Scale. Multivariable logistic regression identified independent predictors, adjusting for age, BMI, and glycated hemoglobin (HbA1c).

RESULTS

Overall discordance was independently associated with advancing age (p <.05). Isolated USG-detected steatosis with low FIB-4 risk was predicted by higher BMI (OR = 1.067, p = .025), elevated C-reactive protein (OR = 1.084, p = 0.010), and higher EAT-40 scores (OR = 1.037, p = .020). Conversely, elevated FIB-4 with normal USG was associated with older age (OR = 1.095, p <.001) and inversely with BMI (OR = 0.900, p = .040). General psychological measures showed no significant associations.

CONCLUSION

USG and FIB-4 dissociation reflects expected differences in pathological domains as well as the biological heterogeneity of metabolic dysfunction-associated steatotic liver disease (MASLD) rather than diagnostic inconsistency. Disordered eating behaviors were independently associated with isolated USG-detected steatosis phenotypes, whereas fibrosis risk is primarily associated with advancing age. Managing MASLD requires integrating both metabolic and behavioral assessments.