{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:34:53Z","timestamp":1787567693327,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Fund of the State Key Laboratory of Infrared Physics","award":["SITP-NLIST-YB-2023-02"],"award-info":[{"award-number":["SITP-NLIST-YB-2023-02"]}]},{"award":["SITP-NLIST-YB-2023-02"],"award-info":[{"award-number":["SITP-NLIST-YB-2023-02"]}],"id":[{"id":"https:\/\/ror.org\/02nazt902","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with ectopic fat accumulation and alterations in adipose tissue function. However, the relationships of structural and thermogenic adipose imaging markers with hepatic steatosis remain incompletely understood. This study aimed to jointly evaluate the cross-sectional associations of epicardial adipose tissue (EAT) thickness and infrared thermography (IRT)-derived brown adipose tissue (BAT)-related thermogenic activity with controlled attenuation parameter (CAP)-defined hepatic steatosis severity in adults with suspected MASLD. Methods: In this cross-sectional study, 207 adults undergoing clinical evaluation for suspected MASLD underwent transient elastography to obtain the controlled attenuation parameter (CAP) for hepatic steatosis assessment. EAT thickness was measured by transthoracic echocardiography, and BAT-related thermogenic activity was assessed by infrared thermography using the supraclavicular-to-chest temperature difference (\u0394Temp). Associations of these adipose imaging phenotypes with CAP were evaluated using correlation analyses, sequential multivariable linear regression models, and BAT-stratified analyses. Results: EAT thickness increased progressively across CAP-defined steatosis grades (p &lt; 0.001) and was positively correlated with CAP (r = 0.637, p &lt; 0.001), whereas \u0394Temp decreased with increasing steatosis severity and was inversely correlated with CAP (\u03c1 = \u22120.277, p &lt; 0.001). In sequential multivariable regression models, EAT thickness remained independently associated with CAP across adjustments for age, sex, body mass index, metabolic variables, and \u0394Temp (standardized \u03b2 = 0.559\u20130.623; all p &lt; 0.001). Both EAT thickness and \u0394Temp were independently associated with CAP in the fully adjusted model, with a stronger association for EAT thickness (standardized \u03b2 = 0.559 vs. \u22120.167; p &lt; 0.001 and p = 0.004, respectively). Stratified analyses demonstrated consistent associations between EAT thickness and CAP across both BAT-low and BAT-high activity groups. Conclusions: Greater EAT thickness and lower IRT-derived \u0394Temp were independently associated with greater CAP-defined hepatic steatosis severity, with EAT thickness showing the stronger standardized association. These complementary structural and thermogenic imaging correlates warrant prospective evaluation to clarify their directionality and clinical relevance.<\/jats:p>","DOI":"10.3390\/diagnostics16172696","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:20:02Z","timestamp":1787563202000},"page":"2696","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["EAT Thickness and BAT-Related Thermogenesis: Dual Imaging Phenotypes Associated with Hepatic Steatosis Severity in MASLD"],"prefix":"10.3390","volume":"16","author":[{"given":"Xing","family":"Hu","sequence":"first","affiliation":[{"name":"Center of Ultrasound and Functional Diagnosis, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tieying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center of Ultrasound and Functional Diagnosis, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuhui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center of Ultrasound and Functional Diagnosis, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Han","sequence":"additional","affiliation":[{"name":"Center of Ultrasound and Functional Diagnosis, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Infrared Physics, Shanghai Institute of Technical Physics, Chinese Academy of Sciences, No. 500 Yutian Road, Hongkou District, Shanghai 200083, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center of Ultrasound and Functional Diagnosis, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"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":"433","DOI":"10.1111\/apt.18451","article-title":"Meta-Analysis: Global Prevalence and Mortality of Cirrhosis in Metabolic Dysfunction-Associated Steatotic Liver Disease","volume":"61","author":"Owrangi","year":"2025","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/S2468-1253(25)00188-8","article-title":"Risk of Hepatic and Extrahepatic Outcomes Associated with Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction and Alcohol-Associated Steatotic Liver Disease: A Systematic Review and Meta-Analysis","volume":"10","author":"Celsa","year":"2025","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1136\/gutjnl-2023-330595","article-title":"MASLD: A Systemic Metabolic Disorder with Cardiovascular and Malignant Complications","volume":"73","author":"Targher","year":"2024","journal-title":"Gut"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/S2468-1253(24)00193-6","article-title":"Natural History and Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease","volume":"9","author":"Shang","year":"2024","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1002\/oby.24239","article-title":"Features, Functions, and Associated Diseases of Visceral and Ectopic Fat: A Comprehensive Review","volume":"33","author":"Luo","year":"2025","journal-title":"Obesity"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1038\/s41569-022-00679-9","article-title":"Epicardial Adipose Tissue in Contemporary Cardiology","volume":"19","author":"Iacobellis","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Orci, L.A., Jornayvaz, F.R., Toso, C., and Gariani, K. (2022). Systematic Review and Meta-Analysis of the Usefulness of Epicardial Fat Thickness as a Non-Invasive Marker of the Presence and Severity of Nonalcoholic Fatty Liver Disease. Biomedicines, 10.","DOI":"10.3390\/biomedicines10092204"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s00330-017-5075-6","article-title":"Increased Severity of Liver Fat Content and Liver Fibrosis in Non-Alcoholic Fatty Liver Disease Correlate with Epicardial Fat Volume in Type 2 Diabetes: A Prospective Study","volume":"28","author":"Brouha","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.jhep.2016.01.025","article-title":"Metabolic Interplay between White, Beige, Brown Adipocytes and the Liver","volume":"64","author":"Scheja","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4089","DOI":"10.2337\/db14-0746","article-title":"Brown Adipose Tissue Improves Whole-Body Glucose Homeostasis and Insulin Sensitivity in Humans","volume":"63","author":"Chondronikola","year":"2014","journal-title":"Diabetes"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1038\/s41591-020-1126-7","article-title":"Brown Adipose Tissue Is Associated with Cardiometabolic Health","volume":"27","author":"Becher","year":"2021","journal-title":"Nat. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100397","DOI":"10.1016\/j.xcrm.2021.100397","article-title":"Lower Brown Adipose Tissue Activity Is Associated with Non-Alcoholic Fatty Liver Disease but Not Changes in the Gut Microbiota","volume":"2","author":"Ahmed","year":"2021","journal-title":"Cell Rep. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1002\/oby.22560","article-title":"Brown Adipose Tissue: Multimodality Evaluation by PET, MRI, Infrared Thermography, and Whole-Body Calorimetry (TACTICAL-II)","volume":"27","author":"Sun","year":"2019","journal-title":"Obesity"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wu, M., Junker, D., Branca, R.T., and Karampinos, D.C. (2020). Magnetic Resonance Imaging Techniques for Brown Adipose Tissue Detection. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00421"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1002\/oby.22635","article-title":"Infrared Thermography for Estimating Supraclavicular Skin Temperature and BAT Activity in Humans: A Systematic Review","volume":"27","author":"Villarroya","year":"2019","journal-title":"Obesity"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11154-020-09539-8","article-title":"A Systematic Review on the Role of Infrared Thermography in the Brown Adipose Tissue Assessment","volume":"21","author":"Brasil","year":"2020","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1111\/liv.12282","article-title":"Controlled Attenuation Parameter (CAP) for Detection of Hepatic Steatosis in Patients with Chronic Liver Diseases: A Prospective Study of a Native Korean Population","volume":"34","author":"Chon","year":"2014","journal-title":"Liver Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jhep.2016.12.022","article-title":"Individual Patient Data Meta-Analysis of Controlled Attenuation Parameter (CAP) Technology for Assessing Steatosis","volume":"66","author":"Karlas","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/j.jhep.2023.06.003","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"79","author":"Rinella","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.echo.2009.10.013","article-title":"Echocardiographic Epicardial Fat: A Review of Research and Clinical Applications","volume":"22","author":"Iacobellis","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e12167","DOI":"10.14814\/phy2.12167","article-title":"Infrared Thermography in the Detection of Brown Adipose Tissue in Humans","volume":"2","author":"Jang","year":"2014","journal-title":"Physiol. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"11934","DOI":"10.1038\/s41598-017-11537-x","article-title":"Optimizing the Methodology for Measuring Supraclavicular Skin Temperature Using Infrared Thermography; Implications for Measuring Brown Adipose Tissue Activity in Humans","volume":"7","author":"Haq","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Nirengi, S., Wakabayashi, H., Matsushita, M., Domichi, M., Suzuki, S., Sukino, S., Suganuma, A., Kawaguchi, Y., Hashimoto, T., and Saito, M. (2019). An Optimal Condition for the Evaluation of Human Brown Adipose Tissue by Infrared Thermography. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0220574"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1080\/03007995.2018.1462786","article-title":"Epicardial Adipose Tissue and Atrial Fibrillation: Pathophysiological Mechanisms, Clinical Implications, and Potential Therapies","volume":"34","author":"Goudis","year":"2018","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1002\/oby.20624","article-title":"Epicardial Fat Thickness and Nonalcoholic Fatty Liver Disease in Obese Subjects","volume":"22","author":"Iacobellis","year":"2014","journal-title":"Obesity"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s12072-019-09972-1","article-title":"Association of Epicardial Adipose Tissue with Non-Alcoholic Fatty Liver Disease: A Meta-Analysis","volume":"13","author":"Liu","year":"2019","journal-title":"Hepatol. Int."},{"key":"ref_28","first-page":"1096","article-title":"The Association between Epicardial Adipose Tissue and Non-Alcoholic Fatty Liver Disease: A Systematic Review of Existing Human Studies","volume":"20","author":"Emamat","year":"2021","journal-title":"EXCLI J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.atherosclerosis.2014.10.004","article-title":"Arterial Stiffness in Patients with Non-Alcoholic Fatty Liver Disease Is Related to Fibrosis Stage and Epicardial Adipose Tissue Thickness","volume":"237","author":"Sunbul","year":"2014","journal-title":"Atherosclerosis"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.jacl.2016.01.008","article-title":"Relationship of Epicardial Fat Thickness and Nonalcoholic Fatty Liver Disease to Coronary Artery Calcification: From the CAESAR Study","volume":"10","author":"Kim","year":"2016","journal-title":"J. Clin. Lipidol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Lai, Y.-H., Su, C.-H., Hung, T.-C., Yun, C.-H., Tsai, C.-T., Yeh, H.-I., and Hung, C.-L. (2022). Association of Non-Alcoholic Fatty Liver Disease and Hepatic Fibrosis with Epicardial Adipose Tissue Volume and Atrial Deformation Mechanics in a Large Asian Population Free from Clinical Heart Failure. Diagnostics, 12.","DOI":"10.3390\/diagnostics12040916"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.cmet.2014.12.008","article-title":"NRG4: An Endocrine Link between Brown Adipose Tissue and Liver","volume":"21","author":"Pfeifer","year":"2015","journal-title":"Cell Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1111\/j.1365-2036.2011.04723.x","article-title":"Association between the Presence of Brown Adipose Tissue and Non-Alcoholic Fatty Liver Disease in Adult Humans","volume":"34","author":"Yilmaz","year":"2011","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lee, V., Han, Y., Toh, D.-F., Bryant, J.A., Boubertakh, R., Le, T.-T., and Chin, C.W.L. (2024). Differential Association of Abdominal, Liver, and Epicardial Adiposity with Anthropometry, Diabetes, and Cardiac Remodeling in Asians. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1439691"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2696\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:35:45Z","timestamp":1787564145000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/17\/2696"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":34,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16172696"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16172696","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]}}}