Machine learning-based model for predicting metabolic dysfunction-associated steatotic liver disease using non-invasive parameters in young adults

Kyungchul Song¹Yu-Jin Kwon²Eunju Lee²Young Hoon Youn²SU JUNG BAIK²Hye Sun Lee^2*Hyun Wook Chae^2*

• ¹Yonsei University College of Medicine,, Seoul, Republic of Korea
• ²Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly being diagnosed in young adults and is associated with long-term hepatic complications. Early detection remains challenging in asymptomatic individuals, highlighting the need for accurate and non-invasive risk assessment tools. Methods: We developed and validated a machine learning (ML)-based model to predict MASLD in adults aged 20–40 years. A total of 13,047 participants from the Gangnam Severance Hospital were included in the training set, and 1,335 participants from the Yongin Severance Hospital were included in the external validation set. MASLD was defined as hepatic steatosis on ultrasonography with at least one cardiometabolic risk factor. Three models were constructed using stepwise variable addition: Model 1 (age, sex), Model 2 (Model 1 + body mass index [BMI], mean blood pressure), and Model 3 (Model 2 + bioelectrical impedance analysis [BIA] metrics, including percentage of body fat [PBF] and skeletal muscle index [SMI]). Logistic regression (LR), random forest (RF), and extreme gradient boosting (XGB) were also applied. Results: In internal validation, Model 3 achieved the highest area under the receiver operating characteristic curve (AUROC): 0.90 (LR), 0.91 (RF), and 0.91 (XGB), with accuracies up to 0.81. External validation confirmed a strong performance with AUROCs of 0.89 (LR), 0.88 (RF), and 0.88 (XGB). BMI and PBF were the strongest predictors, whereas a higher SMI was unexpectedly associated with greater MASLD risk. Conclusions: Our ML-based model using non-invasive parameters accurately predicted MASLD risk in young adults and may facilitate early screening in clinical practice.