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Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a multisystem cardiometabolic condition. Because cardiometabolic abnormalities are components of the diagnostic framework, studies describing their prevalence in MASLD must distinguish phenotypic characterization from criterion-independent association testing.Objective: To compare the clinical, biochemical, and routine-care liver-stiffness profiles of adults with and without MASLD in a tertiary-care setting and to describe how metabolic comorbidity burden varied acr...oss imaging-defined steatosis grades.Methods: This retrospective comparative study included 850 adults. MASLD was operationally defined by both imaging-confirmed hepatic steatosis and at least one documented cardiometabolic risk factor. Between-group comparisons used independent-samples t tests, Mann–Whitney U tests, or chi-square tests, as appropriate. Adjusted odds ratios for comorbidities were treated as exploratory and criterion-dependent because type 2 diabetes mellitus, hypertension, and dyslipidemia contributed to MASLD ascertainment. Across steatosis grades, binary outcomes were evaluated by logistic trend models and continuous outcomes by linear regression with grade coded 1–3.Results: Of 850 patients, 432 (50.8%) met the operational MASLD definition and 418 (49.2%) had no imaging evidence of steatosis. The MASLD group had higher body mass index, aminotransferases, gamma-glutamyl transferase, triglycerides, glycated hemoglobin, and liver stiffness, and lower high-density lipoprotein cholesterol. Type 2 diabetes mellitus and dyslipidemia were more frequent in the MASLD group; however, these comparisons are partly criterion-dependent and should not be interpreted as independent validation of association. Within the MASLD group, increasing steatosis grade was accompanied by higher metabolic comorbidity burden and worsening biochemical and liver-stiffness measurements.Conclusion: In this tertiary-care cohort, the operational MASLD definition identified patients with an adverse hepatic and cardiometabolic profile. The graded patterns across steatosis severity support integrated metabolic and liver-risk assessment, but the retrospective cross-sectional design, incorporation of cardiometabolic factors into case definition, and non-histologic nature of liver-stiffness measurements limit causal and criterion-independent interpretation.
https://orcid.org/0009-0007-6870-1822 
