Abstract
BACKGROUND: The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) spectrum, beginning with hepatic steatosis, requires prompt diagnosis to improve prognostic outcomes. This study aims to assess central obesity measures, including visceral fat area (VFA), subcutaneous fat area (SFA), and waist circumference (WC), along with components of metabolic syndrome, to predict the presence of hepatic steatosis (MASLD). METHODS: This analytical cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. All participants aged above 18 years who underwent an unenhanced CT abdomen examination and had relevant blood workup were enrolled. Purposive sampling was used to select participants based on predefined eligibility criteria. Data was collected using a structured questionnaire to assess predictors and MASLD status among study participants. Descriptive statistics were used, and multiple logistic regression was performed to report the prevalence odds ratio with a 95% confidence interval. ROC curve analysis was conducted for VFA and triglycerides. AUC with 95% confidence interval, sensitivity and specificity were reported for these predictors. All the analysis was conducted on SPSS version 19. RESULTS: A total of 162 patients’ data was analyzed. MASLD was present in 83 patients (51.2%). The prevalence odds of visceral fat adiposity among patients with MASLD was 1.01 times compared to patients with healthy liver (P-value < 0.001). Additionally, body mass index (P-value 0.01), triglyceride levels (P-value 0.01) and superficial fat adiposity (P-value < 0.001) were all significantly associated with the presence of MASLD. The multiple logistic regression model included VFA (P-value < 0.001) and triglyceride levels (P-value 0.05) as a significant predictor for the presence of MASLD. Furthermore, VFA has an AUC of 0.69 (95% confidence interval: 0.61–0.77) with sensitivity 66.27% and specificity 62.03%, while triglycerides have an AUC 0.61 (95% confidence interval: 0.52–0.69) with sensitivity 59.04% and specificity 63.29%. CONCLUSION: In conclusion visceral fat adiposity and serum triglycerides are predictors of fatty changes seen in the liver. Larger population-based studies are recommended to develop cut-offs for visceral fat adiposity as a reliable screening tool for categorizing obesity and its potential complications. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12880-026-02159-9.