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Fatty liver was diagnosed via ultrasonography findings. Exclusion criteria included those with other liver diseases, such as chronic viral hepatitis. Participants underwent liver stiffness measurement using Fibroscan, and clinical data and liver function tests were collected, and questionnaires for DASS-21 and the Pittsburg Sleep Quality Index (PSQI) were completed. We conducted a chi-square test and ANOVA test to evaluate and explore the extrahepatic comorbidities and manifestations associated with fatty liver disease. Results: Of the 385 study participants, 50.6% had severe steatosis, and 29.1% had severe fibrosis. Several comorbidities, such as hypertension (fibrosis: P=0.033, steatosis: P=0.011), diabetes (fibrosis: P=0.006, steatosis: P=0.002), and poor sleep quality (fibrosis: P=0.015), were significantly associated with the severity of non-alcoholic fatty liver disease (NAFLD). There were statistically significant differences in mean scores of depression and anxiety across different levels of fibrosis and steatosis (P&lt;0.05). Conclusion: MASLD is a multisystem disorder with widespread extrahepatic manifestations impacting many organs and systems. Patients with MASLD should be screened for comorbidities such as diabetes, cardiovascular disease, and mental health conditions to improve overall health outcomes and prevent disease advancement.<\/jats:p>","DOI":"10.34172\/mejdd.2025.413","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T19:25:32Z","timestamp":1765653932000},"page":"96-104","update-policy":"https:\/\/doi.org\/10.34172\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Extrahepatic Comorbidities Associated with Metabolic Dysfunction-Associated Steatotic Liver Disease; A Tertiary Hospital Experience"],"prefix":"10.34172","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5688-2776","authenticated-orcid":true,"given":"Masoudreza","family":"Sohrabi","sequence":"first","affiliation":[{"name":"Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mozhdeh","family":"Mosalli","sequence":"additional","affiliation":[{"name":"Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvin","family":"Hassanzadeh","sequence":"additional","affiliation":[{"name":"Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somayeh","family":"Bahrami","sequence":"additional","affiliation":[{"name":"Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoodreza","family":"Khoonsari","sequence":"additional","affiliation":[{"name":"Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Ajdarkosh","sequence":"additional","affiliation":[{"name":"Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4238-5344","authenticated-orcid":true,"given":"Farhad","family":"Zamani","sequence":"additional","affiliation":[{"name":"Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"20123","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16183415"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jlr.2023.100485"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)32511-3"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.3390\/life13112144"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2022.0424"},{"key":"R6","first-page":"4731","article-title":"The epidemiology of non-alcoholic fatty liver disease and its connection with cardiovascular disease: role of endothelial dysfunction","volume":"20","author":"Federico A","year":"2016","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1111\/jdi.13756"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.12.004"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18105227"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000034934"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2023.101506"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.156004"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15195"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.2061"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2023.01.007"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-1253(21)00020-0"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2020.0239"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.30699\/ijp.2017.25038"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000000852"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.17795\/jhealthscope-15547"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-010-0478-5"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2015.01.009"},{"key":"R23","unstructured":"Khorami Rad A, Noroozi M, Ahmari Tehran H, Rahmani A. 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