Psychometric profiles and the phenotypic dissociation of imaging steatosis and elevated fibrosis risk in obesity.

OBJECTIVE: To evaluate the relationship between psychometric profiles and the phenotypic discordance of ultrasonography (USG)-detected steatosis and Fibrosis-4 (FIB-4) risk in obesity. METHODS: This retrospective study included 206 patients with obesity (body mass index [BMI] ≥ 30 kg/m2). We categorized participants into concordant and discordant phenotypes based on USG findings and FIB-4 scores. Psychometric assessments included the Beck Depression Inventory, Eating Attitudes Test-40 (EAT-40), Body Cathexis Scale, and Emotional Eating Scale. Multivariable logistic regression identified independent predictors, adjusting for age, BMI, and glycated hemoglobin (HbA1c). RESULTS: Overall discordance was independently associated with advancing age (p <.05). Isolated USG-detected steatosis with low FIB-4 risk was predicted by higher BMI (OR = 1.067, p = .025), elevated C-reactive protein (OR = 1.084, p = 0.010), and higher EAT-40 scores (OR = 1.037, p = .020). Conversely, elevated FIB-4 with normal USG was associated with older age (OR = 1.095, p <.001) and inversely with BMI (OR = 0.900, p = .040). General psychological measures showed no significant associations. CONCLUSION: USG and FIB-4 dissociation reflects expected differences in pathological domains as well as the biological heterogeneity of metabolic dysfunction-associated steatotic liver disease (MASLD) rather than diagnostic inconsistency. Disordered eating behaviors were independently associated with isolated USG-detected steatosis phenotypes, whereas fibrosis risk is primarily associated with advancing age. Managing MASLD requires integrating both metabolic and behavioral assessments.