{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:17:57Z","timestamp":1791908277867,"version":"4.3.4"},"reference-count":26,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Hepatic steatosis, a hallmark of metabolic dysfunction-associated steatotic liver disease (MASLD), is closely associated with systemic metabolic dysfunction. However, the cumulative impact of metabolic risk factors on liver fat content remains underexplored. To evaluate the association between metabolic risk factors and hepatic steatosis severity using magnetic resonance imaging proton density fat fraction (MR-PDFF) measurement, and to assess the cumulative effect of multiple metabolic abnormalities. Methods: In this cross-sectional study, MASLD patients (n = 132, aged \u2265 18 years, age: 61.3 \u00b1 10.3, male: 54, female: 78) underwent metabolic risk assessment and MR-PDFF liver fat content measurement. The association between certain metabolic risk scores (obesity\/overweight, hypertension, hypercholesterolemia, hypertriglyceridemia, impaired fasting glucose or type 2 diabetes mellitus) both continuous and categorized, as well as liver fat content was analyzed using linear regression models. The cumulative effect of increasing metabolic risk was further explored with subgroup comparisons. Results: A significant positive association was observed between continuous metabolic risk scores and MR-PDFF values (\u03b2 = 0.021, p &lt; 0.001). Participants with higher cumulative metabolic risk (4 and 5 risk factors group) showed significantly higher liver fat content compared to the reference group (p &lt; 0.01) (MetfO0 = 5.7 \u00b1 5.9%; MetfO1 = 11.6 \u00b1 9.5%; MetfO2 = 7.9 \u00b1 5.6%; MetfO3 = 10.2 \u00b1 7.9%; MetfO4 = 16.4 \u00b1 11.0%; MetfO5 = 17.8 \u00b1 9.5%). Intermediate metabolic risk categories showed a trend toward increased steatosis but did not reach statistical significance. Conclusions: Cumulative metabolic risk is strongly associated with increased hepatic fat accumulation. These findings underscore the need for early identification and management of metabolic risk factors to prevent the development and progression of hepatic steatosis.<\/jats:p>","DOI":"10.3390\/diagnostics15182406","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T10:05:17Z","timestamp":1758535517000},"page":"2406","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cumulative Effect of Metabolic Factors on Hepatic Steatosis"],"prefix":"10.3390","volume":"15","author":[{"given":"Anna","family":"Egresi","sequence":"first","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitta","family":"Kozma","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rton","family":"Kar\u00e1csony","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alad\u00e1r","family":"R\u00f3nasz\u00e9ki","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kl\u00e1ra","family":"Werling","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Csongr\u00e1dy","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e1l Kaposi","family":"Nov\u00e1k","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3312-0581","authenticated-orcid":false,"given":"Anik\u00f3","family":"Folhoffer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"Szij\u00e1rt\u00f3","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5859-1320","authenticated-orcid":false,"given":"Krisztina","family":"Hagym\u00e1si","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.3350\/cmh.2024.0431","article-title":"Epidemiology of metabolic dysfunction-associated steatotic liver disease","volume":"31","author":"Younossi","year":"2025","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.cgh.2022.04.023","article-title":"The potential role of fatigue in identifying patients with NASH and advanced fibrosis who experience disease progression","volume":"21","author":"Younossi","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"612","DOI":"10.4254\/wjh.v14.i3.612","article-title":"Interrelationship between physical activity and depression in nonalcoholic fatty liver disease","volume":"14","author":"Weinstein","year":"2022","journal-title":"World J. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease\u2014Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jhep.2020.03.039","article-title":"A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement","volume":"73","author":"Eslam","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_6","unstructured":"Pet\u00e4j\u00e4, E.M., and Yki-J\u00e4rvinen, H. (2021). Definitions of normal liver fat and the association of insulin sensitivity with acquired and genetic NAFLD. Nutrients, 13."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1002\/hep.29797","article-title":"Noninvasive, quantitative assessment of liver fat by MRI-PDFF as an endpoint in NASH trials","volume":"68","author":"Caussy","year":"2018","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"155642","DOI":"10.1016\/j.metabol.2023.155642","article-title":"Nonalcoholic fatty liver disease (NAFLD) and associated mortality in individuals with type 2 diabetes, pre-diabetes, metabolically unhealthy, and metabolically healthy individuals in the United States","volume":"146","author":"Golabi","year":"2023","journal-title":"Metabolism"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1016\/j.cgh.2024.03.006","article-title":"The global epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among patients with type 2 diabetes","volume":"22","author":"Younossi","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.dsx.2020.05.019","article-title":"From nonalcoholic fatty liver disease (NAFLD) to metabolic associated fatty liver disease (MAFLD): A journey over 40 years","volume":"14","author":"Kuchay","year":"2020","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/S1499-3872(17)60019-5","article-title":"Gut microbiota dysbiosis in patients with non-alcoholic fatty liver disease","volume":"16","author":"Shen","year":"2017","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_12","unstructured":"World Health Organization (2024, June 03). Obesity and Overweight. WHO Web Site. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S2468-1253(22)00317-X","article-title":"Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: A systematic review and meta-analysis","volume":"8","author":"Quek","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s11906-023-01242-8","article-title":"Mechanisms Linking Metabolic-Associated Fatty Liver Disease (MAFLD) to Cardiovascular Disease","volume":"25","author":"Badmus","year":"2023","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.atherosclerosis.2015.02.011","article-title":"The association of nonalcoholic fatty liver disease, obesity, and metabolic syndrome, with systemic inflammation and subclinical atherosclerosis: The Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"239","author":"Silverman","year":"2015","journal-title":"Atherosclerosis"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1186\/s12933-024-02434-5","article-title":"Metabolic dysfunction-associated steatotic liver disease and cardiovascular risk: A comprehensive review","volume":"23","author":"Zheng","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1148\/radiol.14140754","article-title":"Accuracy of MR imaging\u2013estimated proton density fat fraction for classification of steatosis grade in nonalcoholic fatty liver disease","volume":"274","author":"Tang","year":"2015","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.jhep.2017.11.013","article-title":"Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers","volume":"68","author":"Chalasani","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"103910","DOI":"10.1016\/j.drudis.2024.103910","article-title":"NAFLD and NASH: Etiology, targets and emerging therapies","volume":"29","author":"Wei","year":"2024","journal-title":"Drug Discov. Today"},{"key":"ref_20","unstructured":"European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), and European Association for the Study of Obesity (EASO) (2024). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J. Hepatol., 81, 492\u2013542."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Jarvis, H., Craig, D., Barker, R., Spiers, G., Stow, D., Anstee, Q.M., and Hanratty, B. (2020). Metabolic risk factors and incident advanced liver disease in non-alcoholic fatty liver disease (NAFLD): A systematic review and meta-analysis of population-based observational studies. PLoS Med., 17.","DOI":"10.1371\/journal.pmed.1003100"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"497","DOI":"10.5009\/gnl220276","article-title":"Fatty liver disease and cardiovascular risk: Impact of metabolic dysfunctions","volume":"16","author":"Lee","year":"2022","journal-title":"Gut Liver"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1016\/j.cgh.2020.12.022","article-title":"Metabolic dysfunction-associated fatty liver disease and incident cardiovascular disease risk: A nationwide cohort study","volume":"19","author":"Lee","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1136\/gutjnl-2020-323082","article-title":"Non-alcoholic fatty liver disease and risk of incident chronic kidney disease: An updated meta-analysis","volume":"71","author":"Mantovani","year":"2022","journal-title":"Gut"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.eprac.2022.03.010","article-title":"American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: Co-sponsored by the American Association for the Study of Liver Diseases (AASLD)","volume":"28","author":"Cusi","year":"2022","journal-title":"Endocr. Pract."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2406\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:56Z","timestamp":1760035616000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2406"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":26,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15182406"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15182406","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]}}}