Sezer Semih, Demirci Selim
Department of Gastroenterology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey.
Medicine (Baltimore). 2025 Jul 25;104(30):e43584. doi: 10.1097/MD.0000000000043584.
The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is steadily increasing and visceral adiposity plays a pivotal role in its development. The maximum preperitoneal fat thickness (PMFT) and abdominal fat index (AFI), when measured via ultrasound, are practical, cost-effective, and reliable indices that best estimate visceral fat area, as measured by CT. This study aimed to explore the relationship between MASLD and PMFT by using ultrasound, a noninvasive and dependable diagnostic modality. This retrospective study used data from patients consecutively evaluated for MASLD at the Hepatology Clinic of Dr Abdurrahman Yurtaslan Hospital between July and December 2024. PMFT, AFI, and minimum subcutaneous fat thickness (SMFT) values were compared between patients with and without a diagnosis of MASLD. As the PMFT and AFI parameters are interrelated variables, they were analyzed using 2 separate regression models. Independent variables considered risk factors for MASLD (age, sex, exercise, PMFT, and AFI) were included in the binary logistic regression analysis. Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC) values for PMFT, AFI, and SMFT to evaluate their ability to distinguish between MASLD and non-MASLD cases. This study included 130 patients, 71 diagnosed with MASLD and 59 without MASLD. In the regression analysis, MASLD was positively associated with PMFT (odds ratio [OR] = 33.626, 95% confidence interval [CI]: 11.498-98.338, P < .001) after adjusting for confounding and clinical variables. Furthermore, AFI was independently associated with MASLD (OR = 3.492, 95% CI: 1.418-8.599, P < .001). PMFT values showed significant diagnostic accuracy in distinguishing MASLD from non-MASLD (AUC, P < .001) with an optimal cutoff of > 15.9 mm. Similarly, AFI values were significant (AUC, P < .01) with the best cutoff of > 1.18. In contrast, the SMFT values did not demonstrate significant diagnostic accuracy (AUC, P > .05). PMFT and AFI showed significant diagnostic value in distinguishing MASLD, with PMFT being the most strongly associated marker. These findings support their use as practical, noninvasive tools for early MASLD diagnosis and risk assessment, whereas the SMFT lacks diagnostic relevance.
代谢功能障碍相关脂肪性肝病（MASLD）的患病率正在稳步上升，内脏肥胖在其发展过程中起着关键作用。通过超声测量的最大腹膜前脂肪厚度（PMFT）和腹部脂肪指数（AFI）是实用、经济高效且可靠的指标，能够最好地估计通过CT测量的内脏脂肪面积。本研究旨在通过使用超声这一非侵入性且可靠的诊断方式，探讨MASLD与PMFT之间的关系。这项回顾性研究使用了2024年7月至12月期间在阿卜杜勒拉赫曼·尤尔塔斯兰医院肝病诊所连续评估的MASLD患者的数据。比较了确诊和未确诊MASLD患者的PMFT、AFI和最小皮下脂肪厚度（SMFT）值。由于PMFT和AFI参数是相互关联的变量，因此使用两个独立的回归模型对它们进行分析。二元逻辑回归分析纳入了被视为MASLD危险因素的自变量（年龄、性别、运动、PMFT和AFI）。进行了受试者工作特征分析，以计算PMFT、AFI和SMFT的曲线下面积（AUC）值，以评估它们区分MASLD和非MASLD病例的能力。本研究纳入了130名患者，其中71名被诊断为MASLD，59名未患MASLD。在回归分析中，在调整混杂因素和临床变量后，MASLD与PMFT呈正相关（优势比[OR]=33.626，95%置信区间[CI]：11.498-98.338，P<.001）。此外，AFI与MASLD独立相关（OR=3.492，95%CI：1.418-8.599，P<.001）。PMFT值在区分MASLD与非MASLD方面显示出显著的诊断准确性（AUC，P<.001），最佳截断值>15.9mm。同样，AFI值也具有显著性（AUC，P<.01），最佳截断值>1.18。相比之下，SMFT值未显示出显著的诊断准确性（AUC，P>.05）。PMFT和AFI在区分MASLD方面显示出显著的诊断价值，其中PMFT是关联最强的标志物。这些发现支持将它们用作早期MASLD诊断和风险评估的实用非侵入性工具，而SMFT缺乏诊断相关性。
