{
  "abstract": "Background Metabolic dysfunction–associated steatotic liver disease (MASLD) has emerged as the most common chronic liver disorder worldwide, quietly expanding alongside the global surge in obesity, diabetes, and sedentary lifestyles. Traditional markers such as body mass index fail to capture the complex interplay of fat distribution and metabolic dysfunction, particularly in Asian populations where visceral adiposity predominates despite lower BMI. Increasing evidence highlights body composition, especially visceral fat, as a key driver of disease severity. Understanding this intricate relationship is essential for early risk stratification, targeted interventions, and improved clinical outcomes in MASLD.Methods Prospective observational study in a tertiary care centre including 151 patients meeting criteria for MASLD over 18 months. Clinical, biochemical, and cardiometabolic parameters were recorded. Liver stiffness and fat fraction were assessed using MRI/MRE, with statistical correlation analyses performed. Body composition was analysed from physical parameters and using MRE.Results The study population showed an almost equal gender distribution; patients with MASLDdemonstrated significant associations between body composition and disease severity. Table 1(IDDF2026-ABS-0530 Table 1) showed that diabetic individuals had higher visceral fat, hepatic fat fraction, and liver stiffness compared to non-diabetics, indicating a worse metabolic and hepatic profile. Table 2 (IDDF2026-ABS-0530 Table 2) revealed that cirrhotic patients exhibited markedly increased visceral adiposity and reduced subcutaneous fat, suggesting a shift toward unfavorable fat distribution. Correlation analysis in Table 3 (IDDF2026-ABS-0530 Table 3) demonstrated a strong positive relationship between visceral fat and liver stiffness, while anthropometric measures such as BMI showed weaker associations. Tables 4 and 5 (IDDF2026-ABS-0530 Table 4, IDDF2026-ABS-0530 Table 5) highlighted that across BMI categories, visceral fat and waist circumference remained significantly elevated in cirrhotic patients, even in those with lower BMI. Table 6 (IDDF2026-ABS-0530 Table 6) further showed altered subcutaneous fat distribution, reinforcing the limitation of BMI alone. Overall, central adiposity consistently correlated with fibrosis severity and cardiometabolic risk, emphasizing its role as a key determinant of MASLD progression.Conclusions Central adiposity emerged as a key determinant of MASLD severity. Visceral fat strongly correlated with liver stiffness, fibrosis, and adverse cardiometabolic profiles, outperforming BMI. Cirrhotic and diabetic patients showed unfavorable fat distribution. Across BMI categories, visceral fat remained predictive, underscoring the need for body composition–based risk stratification beyond conventional anthropometric measures.Abstract IDDF2026-ABS-0530 Table 1Comparison of hepatic and body composition parameters between diabetic and non-diabetic participantsHepatic and Body Composition ParametersDiabetes (n=77)Non-Diabetes (n=74)P-valueMean ± SDMean ± SDLiver Stiffness6.02 ± 0.865.88 ± 0.560.23Visceral fat197.02 ± 60.84190.87 ± 66.140.55Subcutaneous fat320.39 ± 119.99379.61 ± 132.300.0045Visceral & Subcutaneous fat Ratio0.64 ± 0.110.51 ± 0.12<0.0001BMI (Kg/m2)26.81 ± 3.4828.28 ± 5.100.039Waist circumference (cm)287.28 ± 8.9590.53 ± 13.330.079Cirrhosis (>5kpa)6.02 ± 0.865.87 ± 0.560.21Abstract IDDF2026-ABS-0530 Table 2Comparison of body composition parameters between cirrhotic and non-cirrhotic participantsBody Composition ParametersCirrhosis (n=33)Non-Cirrhosis (118)P-valueMean ± SDMean ± SDVisceral fat184.09 ± 47.62196.79 ± 67.010.18Subcutaneous fat area(cm2)278.03 ± 94.46369.37 ± 130.86<0.0001Visceral & Subcutaneous fat Ratio0.61 ± 0.0710.52 ± 0.073<0.0001BMI (Kg/m2)25.05 ± 3.7928.22 ± 4.320.0032Waist circumference (cm)286.36 ± 8.0489.58 ± 12.100.05Abstract IDDF2026-ABS-0530 Table 3Correlation of body composition and anthropometric parameters with liver stiffness MREVariablerP valueVisceral & Subcutaneous fat Ratio0.3898<0.0001Waist Circumference0.00280.9805Age0.3997<0.0001Subcutaneous fat-0.18420.0237Abstract IDDF2026-ABS-0530 Table 4Comparison of visceral fat across BMI categories in cirrhotic and non-cirrhotic patientsBMI (Kg/m2) leverVisceral Fat (Mean ± SD)P-valueCirrhosis (n=33)Non-Cirrhosis (118)<18--18-24.9146.15 ± 35.19113.70 ± 38.84<0.000125-29.9208.95 ± 38.61198.54 ± 41.690.2>30103 ± 0270.69 ± 36.32-Abstract IDDF2026-ABS-0530 Table 5Waist circumference across BMI categories in cirrhotic and non-cirrhotic patientsBMI (Kg/m2) leverCirrhosis (n=33)Non-Cirrhosis (118)P-valueWaist circumference (Mean ± SD)<18--18-24.983.46 ± 8.3778.96 ± 5.49<0.000125-29.987.47 ± 6.7486.34 ± 7.150.41>30205 ± 0106.24 ± 7.46-Abstract IDDF2026-ABS-0530 Table 6Subcutaneous fat distribution across BMI categories in cirrhotic and non-cirrhotic patientsBMI (Kg/m2) leverCirrhosis (n=33)Non-Cirrhosis (118)P-valueSubcutaneous fat (Mean ± SD)<18--18-24.9210.38 ± 44.27204.07 ± 65.440.625-29.9307.89 ± 70.02363.05 ± 62.33<0.0001>30590 ± 0534.65 ± 66.79-",
  "authors": [
    {
      "affiliations": [
        "Gleneagles Hospital, Mumbai, India"
      ],
      "name": "Kevin Shah"
    },
    {
      "affiliations": [
        "Gleneagles Hospital, Mumbai, India"
      ],
      "name": "Sitaram Sabane"
    },
    {
      "affiliations": [
        "Gleneagles Hospital, Mumbai, India"
      ],
      "name": "Ameet Mandot"
    }
  ],
  "title": "IDDF2026-ABS-0530 Metabolic shadows: the interplay of visceral adiposity and liver disease severity in MASLD",
  "uid": "33c99b50-4d53-5f8d-b27d-446680ce463a"
}