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. 2025 Apr;20(3):785-795.
doi: 10.1007/s11739-025-03880-z. Epub 2025 Apr 9.

Bioelectrical impedance analysis parameters are superior to liver enzymes in predicting metabolic dysfunction-associated steatotic liver disease in young adults

Kyungchul Song  1 , Yu-Jin Kwon  2 , Eunju Lee  3 , Hye Sun Lee  3 , Young Hoon Youn  4 , Su Jung Baik  4 , Hana Lee  1 , Joon Young Kim  1 , Youngha Choi  1 , Hyun Wook Chae  5
Affiliations

Bioelectrical impedance analysis parameters are superior to liver enzymes in predicting metabolic dysfunction-associated steatotic liver disease in young adults

Kyungchul Song et al. Intern Emerg Med. 2025 Apr.

Abstract

Background/aims: The predictive value of bioelectrical impedance analysis (BIA) parameters and liver enzymes for metabolic dysfunction-associated steatotic liver disease (MASLD) in young adults is unclear. We aimed to investigate the usefulness of BIA parameters and liver enzymes in MASLD screening in young adults.

Methods: Overall, 2,647 participants aged 19-30 years were evaluated by sex. Logistic regression analyses were performed with MASLD as the dependent variable. Receiver operating characteristic (ROC) curves were used to compare the predictive ability for MASLD.

Results: In males, percentage body fat (PBF), total body fat (TBF), visceral fat area (VFA), abdominal subcutaneous fat (ASF), alanine aminotransferase (ALT), and elevated ALT levels were positively associated with MASLD, whereas skeletal muscle index (SMI) and AST/ALT were negatively associated after adjusting for age, body mass index, and moderate physical activity. In females, PBF, TBF, ASF, AST, ALT, low SMI (LSMI), and elevated ALT levels were positively associated with MASLD, whereas SMI and AST/ALT were negatively associated. The areas under the ROC curves (AUCs) of PBF, TBF, VFA, ASF, SMI, AST, ALT, and AST/ALT were 0.818, 0.837, 0.834, 0.837, 0.818, 0.653, 0.759, and 0.790 respectively, in males. In females, the corresponding values were 0.915, 0.939, 0.934, 0.940, 0.915, 0.620, 0.799, and 0.849 respectively. The AUC of LSMI was significantly higher than that of increased ALT levels in females.

Conclusions: BIA parameters and ALT levels are useful for predicting MASLD in young adults. BIA parameters have superior predictive ability than liver enzymes.

Keywords: Body composition; Fatty liver; Metabolic dysfunction-associated steatotic liver disease; Young adult.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no conflicts of interest. Ethics approval and informed consent: This study was approved by the Institutional Review Board (IRB) of Yonsei University Gangnam Severance Hospital (IRB number: 3-2023-0409) and conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Written informed consent was obtained from all participants prior to data collection.

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