Integrated model based on ultrasound attenuation and metabolic biomarkers for noninvasive assessment of hepatic fat fraction categories in MASLD: a QCT-referenced study.

As shown in Figure 7 and Table 6 , USAT was the only variable that remained highly significant in the model (OR=2.87, 95% CI: 2.18–3.78, P < 0.001), indicating that for every 0.1-unit increase in USAT, the likelihood of being classified into a higher QCT category nearly tripled.

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AST showed a marginally significant positive association with steatosis category (OR=1.05, P=0.062), suggesting that it may reflect mild hepatocellular stress or early necroinflammatory activity.

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However, ALT (OR=1.02, P=0.174), GGT (OR=1.00, P=0.427), and ALP (OR=1.00, P=0.564) did not reach statistical significance, indicating that these conventional liver enzymes may have limited sensitivity in detecting mild to moderate hepatic fat accumulation, especially in the absence of prominent inflammation or fibrosis.

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