Association Between Ultrasound-Derived Fat Fraction (UDFF) Values and Metabolic Syndrome Laboratory Parameters in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
DOI:
https://doi.org/10.19166/med.v15i2.10815Keywords:
MASLD, UDFF, LIVER STEATOSIS, FATTY LIVER, NAFLD, METABOLIC SYNDROMEAbstract
Background:
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), is highly prevalent worldwide and is strongly associated with metabolic syndrome and its related conditions such as diabetes mellitus and hypertension. Without early detection and intervention, hepatic steatosis can progress to hepatic inflammation, fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC). This study aims to evaluate the relationship between ultrasound-derived fat fraction (UDFF) values and laboratory parameters of metabolic syndrome in MASLD, particularly liver enzymes, lipid profile, and glycemic profile, as well as to determine the optimal UDFF cut-off value for detecting metabolic syndrome risk in Indonesian patients.
Methods:
A cross-sectional study was conducted on 96 patients who underwent UDFF and laboratory assessments including liver enzymes (SGOT/AST, SGPT/ALT), lipid profile (total cholesterol, HDL, LDL, triglycerides), and glycemic profile (HbA1c, fasting blood glucose). Data analysis included bivariate-multivariate correlation and ROC analysis.
Result:
The distribution of UDFF (%) was as follows: normal ≤6% (27.1%; n=26), mild >6–15% (37.5%; n=36), moderate >15–25% (21.9%; n=21), and severe >25% (13.5%; n=13). UDFF showed a moderate positive correlation with SGPT (ρ=0.370; p<0.01) and triglycerides (ρ=0.380; p<0.01), and a weak negative correlation with HDL (ρ=−0.221; p<0.05). A UDFF threshold of 14% was able to predict abnormal SGPT levels and elevated triglycerides.
Conclusions:
UDFF shows a significant correlation with laboratory parameters of metabolic syndrome in MASLD, confirming its potential as an accessible, effective, efficient, non-radiative, and non-invasive imaging modality. These findings support the central role of radiology in the early detection and therapeutic monitoring of MASLD and metabolic syndrome, as well as in preventing disease progression from hepatic steatosis to inflammation, fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Large-scale multicenter validation is required to optimize these findings.
References
1. American Association for the Study of Liver Diseases (AASLD). SLD-597 AASLD 2023 MASLD Decision Tree. 2023.
2. Rinella ME, Sookoian S. From NAFLD to MASLD: updated naming and diagnosis criteria for fatty liver disease. J Lipid Res. 2023 Dec 14;65(1):100485.
3. Tang Y, Gu C. Epidemiological transition of metabolic dysfunction-associated steatotic liver disease-related chronic liver disease and cirrhosis: a comparative study between China and the global population (1990–2021). Front Nutr [Internet]. 2025 Jul 15 [cited 2025 Aug 10];12. Available from: https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1624440/full
4. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatol Baltim Md. 2023 May 1;77(5):1797–835.
5. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Ann Hepatol. 2024 Jan 1;29(1):101133.
6. De Robertis R, Spoto F, Autelitano D, Guagenti D, Olivieri A, Zanutto P, et al. Ultrasound-derived fat fraction for detection of hepatic steatosis and quantification of liver fat content. Radiol Med (Torino). 2023 Oct 1;128(10):1174–80.
7. Yokoo T, Serai SD, Pirasteh A, Bashir MR, Hamilton G, Hernando D, et al. Linearity, Bias, and Precision of Hepatic Proton Density Fat Fraction Measurements by Using MR Imaging: A Meta-Analysis. Radiology. 2018 Feb;286(2):486–98.
8. Tang A, Desai A, Hamilton G, Wolfson T, Gamst A, Lam J, et al. Accuracy of MR Imaging–estimated Proton Density Fat Fraction for Classification of Dichotomized Histologic Steatosis Grades in Nonalcoholic Fatty Liver Disease. Radiology. 2015 Feb;274(2):416–25.
9. Huang YL, Cheng J, Wang Y, Xu XL, Wang SW, Wei L, et al. Hepatic steatosis using ultrasound-derived fat fraction: First technical and clinical evaluation. Clin Hemorheol Microcirc. 2024 Feb 22;86(1–2):51–61.
10. Yanai H, Adachi H, Hakoshima M, Iida S, Katsuyama H. Metabolic-Dysfunction-Associated Steatotic Liver Disease—Its Pathophysiology, Association with Atherosclerosis and Cardiovascular Disease, and Treatments. Int J Mol Sci. 2023 Jan;24(20):15473.
11. Habib S, Johnson A. An overview of pathogenesis of metabolic dysfunction-associated steatotic liver disease. Explor Dig Dis. 2024 Nov 11;3(6):459–73.
12. Boliaki N, Henin G, Bale G, Lanthier N. Impact of Peroxisome Proliferator-Activated Receptor Agonists on Myosteatosis in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease. Discov Med. 2024 Jun 20;36(185):1139–53.
13. Reis-Barbosa PH, Mandarim-de-Lacerda CA. Sodium-glucose cotransporter-2 inhibitor (SGLT2i) plus glucagon-like peptide type 1 receptor combination is more effective than SGLT2i plus dipeptidyl peptidase-4 inhibitor combination in treating obese mice metabolic dysfunction-associated steatotic liver disease (MASLD). Fundam Clin Pharmacol. 2024 Dec;38(6):1059–68.
14. Portincasa P, Khalil M, Mahdi L, Perniola V, Idone V, Graziani A, et al. Metabolic Dysfunction–Associated Steatotic Liver Disease: From Pathogenesis to Current Therapeutic Options. Int J Mol Sci. 2024 Jan;25(11):5640.
15. Greber-Platzer S, Thajer A, Bohn S, Brunert A, Boerner F, Siegfried W, et al. Increased liver echogenicity and liver enzymes are associated with extreme obesity, adolescent age and male gender: analysis from the German/Austrian/Swiss obesity registry APV. BMC Pediatr. 2019 Sep 12;19(1):332.
16. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18-35.
17. Oh RC, Hustead RC, Ali SM, Pantsari MW. Mildly Elevated Liver Transaminase Levels: Causes and Evaluation. Am Fam Physician. 2017;96(11):709-15.
18. Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005;172(3):367-79.
19. Kubale R, Schneider G, Lessenich CPN, Buecker A, Wassenberg S, Torres G, et al. Ultrasound-Derived Fat Fraction for Hepatic Steatosis Assessment: Prospective Study of Agreement With MRI PDFF and Sources of Variability in a Heterogeneous Population. Am J Roentgenol. 2024 Jun;222(6):e2330775.
20. Ferraioli G, Soares Monteiro LB. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol. 2019 Oct 28;25(40):6053–62.
21. Mohamed SM, Shalaby MA, El-Shiekh RA, El-Banna HA, Emam SR, Bakr AF. Metabolic syndrome: risk factors, diagnosis, pathogenesis, and management with natural approaches. Food Chem Adv. 2023 Dec 1;3:100335.
22. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and Management of the Metabolic Syndrome. Circulation. 2005 Oct 25;112(17):2735–52.
23. Saklayen MG. The Global Epidemic of the Metabolic Syndrome. Curr Hypertens Rep. 2018 Feb 26;20(2):12.
24. Verdan S, Torri GB, Marcos VN, Moreira MHS, Defante MLR, Fagundes M da C, et al. Ultrasound-derived fat fraction for diagnosing hepatic steatosis: a systematic review and meta-analysis. Eur Radiol [Internet]. 2025 May 9 [cited 2025 Jul 20]; Available from: https://doi.org/10.1007/s00330-025-11652-8
25. Yan L, Fu J, Juan NJ, Qi LB, Ping WJ. Ultrasound-derived fat fraction: a novel approach for assessing Wilson’s disease-related hepatic steatosis. BMC Gastroenterol. 2025 Jul 1;25:465.
26. Meng L, Wang J, Yang H, Hu Y, Yang Z. Ultrasound-derived fat fraction to assess liver steatosis in obese patients with polycystic ovary syndrome. Clin Exp Med. 2025 Apr 29;25(1):130.
27. Michalopoulou E, Thymis J, Lampsas S, Pavlidis G, Katogiannis K, Vlachomitros D, et al. The Triad of Risk: Linking MASLD, Cardiovascular Disease and Type 2 Diabetes; From Pathophysiology to Treatment. J Clin Med. 2025 Jan;14(2):428.
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Copyright (c) 2026 Rheza Maulana Syahputra, Patricia Jorisal, Vera Nevyta Tarigan, Brian Lucas, Hardianto Setiawan, Andree Kurniawan

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