Non‐invasive assessment of hepatic steatosis by ultrasound‐derived fat fraction in individuals at high‐risk for metabolic dysfunction‐associated steatotic liver disease

Abstract Aims Given the increasing number of individuals developing metabolic dysfunction‐associated steatotic liver disease (MASLD) and the low rate of those with progressive liver disease, there is a pressing need to conceive affordable biomarkers to assess MASLD in general population settings. Herein, we aimed to investigate the performance of the ultrasound‐derived fat fraction (UDFF) for hepatic steatosis in high‐risk individuals. Methods A total of 302 Europeans with obesity, type 2 diabetes, or a clinical history of hepatic steatosis were included in the analyses. Clinical, laboratory, and imaging data were collected using standardized procedures during a single screening visit in Rome, Italy. Hepatic steatosis was defined by controlled attenuation parameter (CAP) or ultrasound‐based Hamaguchi's score. UDFF performance for hepatic steatosis was estimated by the area under the receiver operating characteristic curve (AUC). Results Overall, median (IQR) UDFF was 12% (7–20). UDFF was positively correlated with CAP ( ρ = 0.73, p < 0.0001) and Hamaguchi's score ( ρ = 0.79, p < 0.0001). Independent predictors of UDFF were circulating triglycerides, alanine aminotransferase (ALT), and ultrasound‐measured visceral adipose tissue (VAT). UDFF AUC was 0.89 (0.85–0.93) and 0.92 (0.88–0.95) for CAP‐ and ultrasound‐diagnosed hepatic steatosis, respectively. UDFF AUC for hepatic steatosis was higher than those of fatty liver index (FLI), hepatic steatosis index (HSI), CAP‐score (CAPS), and ALT ( p < 0.0001). Lower age, ALT, and VAT were associated with discordance between UDFF and ultrasound. Conclusions UDFF may be a simple and accurate imaging biomarker to assess hepatic steatosis and monitor changes in hepatic fat content over time or in response to therapeutic interventions beyond clinical trials.