Anxiety and depression symptoms correlate with metabolic indicators in metabolic dysfunction-associated steatotic liver disease patients

doi:10.5498/wjp.v16.i8.117628

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Aug 19, 2026; 16(8): 117628
Published online Aug 19, 2026. doi: 10.5498/wjp.v16.i8.117628

Anxiety and depression symptoms correlate with metabolic indicators in metabolic dysfunction-associated steatotic liver disease patients

Dan Yang, Yan-Ping Fu, Wan-Li Cheng, Dong-Yang Li, Xu-Dong Liu, Zhen-Wei Wei

Zhen-Wei Wei, Wan-Li Cheng, Yan-Ping Fu, Dan Yang, Department of Hepatology and Gastroenterology Diagnosis and Treatment Center, The Fourth People’s Hospital of Nanning, Nanning 530023, Guangxi Zhuang Autonomous Region, China

Xu-Dong Liu, Department of Hepatology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China

Dong-Yang Li, School of Nursing, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China

Co-corresponding authors: Zhen-Wei Wei and Dong-Yang Li.

Author contributions: Wei ZW and Liu XD were responsible for the study conception and design, data collection and analysis, and drafting of the manuscript; Li DY provided critical supervision throughout the research process and contributed to the interpretation of results; Cheng WL participated in patient recruitment, questionnaire administration, and data verification; Fu YP assisted with laboratory specimen collection and metabolic indicator testing; Yang D contributed to imaging data acquisition and quality control procedures. All authors critically reviewed and revised the manuscript, approved the final version for submission, and agree to be accountable for all aspects of the work. We respectfully request approval for Li DY (School of Nursing, Guangxi Medical University) to serve as co-corresponding author alongside Wei ZW for the following reasons: (1) Complementary institutional expertise and independent oversight This study was conducted across two institutions. Wei ZW led clinical data collection at The Fourth People’s Hospital of Nanning, while Li DY provided independent methodological supervision from Guangxi Medical University. The involvement of two corresponding authors from distinct institutions ensures dual accountability and reflects the genuinely collaborative, cross-institutional nature of this research; (2) Substantial and indispensable intellectual contributions Li DY made critical contributions beyond supervisory oversight: She was centrally involved in the overall study design, directed the statistical analysis framework, and played a primary role in interpreting the correlation and regression findings that constitute the core results of this manuscript. These contributions are substantive and non-duplicative of those made by Wei ZW; (3) Responsibility for ongoing correspondence Given that Li DY is based at an academic institution with dedicated research infrastructure, she is well positioned to handle post-publication correspondence, data sharing requests, and future collaborative inquiries related to this work. Wei ZW, as the clinical lead, will remain the primary contact for clinical and patient-related queries; and (4) Alignment with established practice co-corresponding authorship is well-recognized in cross-disciplinary studies involving both clinical and academic research teams. The distinct and complementary roles of Wei ZW (clinical lead) and Li DY (methodological and academic lead) justify shared corresponding authorship, as each is uniquely accountable for different aspects of the work.

AI contribution statement: This work has been partially assisted by AI. Specifically, language polishing, grammar correction, and stylistic refinement were carried out with the support of AI tools. All data, figures, images, charts, tables, and original content presented in this work were created, collected, or generated by the authors and are not AI-generated.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Fourth People’s Hospital of Nanning, Approval No. 2025147. All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki.

Informed consent statement: This study was observational in nature and involved only the use of anonymized routinely collected clinical data and questionnaire information, without any additional intervention. The Ethics Committee of The Fourth People’s Hospital of Nanning approved a waiver of informed consent, as the study posed no more than minimal risk to participants and obtaining individual informed consent was impracticable.

Conflict-of-interest statement: All authors declare that they have no conflict of interest related to this study.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Zhen-Wei Wei, Department of Hepatology and Gastroenterology Diagnosis and Treatment Center, The Fourth People’s Hospital of Nanning, No. 1 Changgang Road Erli, Xingning District, Nanning 530023, Guangxi Zhuang Autonomous Region, China. weizw@126.com

Received: January 13, 2026
Revised: February 11, 2026
Accepted: April 13, 2026
Published online: August 19, 2026
Processing time: 197 Days and 22.5 Hours

Abstract

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 32.4% of the global population and is closely associated with metabolic syndrome. Emerging evidence suggests a bidirectional relationship between MASLD and mental health disorders, with depression and anxiety prevalence significantly elevated in MASLD patients. Anxiety and depression may exacerbate metabolic dysfunction through mechanisms including hypothalamic-pituitary-adrenal axis dysregulation, chronic inflammation, and behavioral changes. However, comprehensive data on the correlation between psychological symptoms and metabolic indicators in MASLD patients remain limited, particularly in Asian populations.

AIM

To investigate the occurrence of anxiety and depression symptoms in patients with MASLD and their correlation with metabolic indicators, providing theoretical basis for comprehensive management of MASLD patients.

METHODS

A cross-sectional study design was adopted, enrolling 328 MASLD patients who visited the Department of Gastroenterology and Endocrinology at a tertiary hospital from January 2023 to June 2024. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess patients’ anxiety and depression symptoms. Metabolic indicators were collected simultaneously, including body mass index (BMI), waist circumference, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspartate aminotransferase, and hepatic fat content. Pearson correlation analysis and multiple linear regression analysis were used to explore the correlation between anxiety and depression symptoms and metabolic indicators.

RESULTS

Among 328 MASLD patients, the detection rate of anxiety symptoms was 41.5% (136/328), depression symptoms was 38.7% (127/328), and anxiety-depression comorbidity was 28.4% (93/328). Correlation analysis showed that SAS scores were positively correlated with BMI (r = 0.423, P < 0.001), waist circumference (r = 0.387, P < 0.001), TG (r = 0.356, P < 0.001), FBG (r = 0.312, P < 0.001), HbA1c (r = 0.298, P < 0.01), and hepatic fat content (r = 0.341, P < 0.001), and negatively correlated with HDL-C (r = -0.267, P < 0.01). SDS scores were positively correlated with BMI (r = 0.401, P < 0.001), waist circumference (r = 0.369, P < 0.001), TG (r = 0.334, P < 0.001), ALT (r = 0.289, P < 0.01), and hepatic fat content (r = 0.318, P < 0.001). Multiple linear regression analysis showed that BMI (β = 0.312, P < 0.001), TG (β = 0.245, P < 0.01), and hepatic fat content (β = 0.198, P < 0.05) were independent correlates of anxiety symptoms; BMI (β = 0.289, P < 0.001), waist circumference (β = 0.231, P < 0.01), and ALT (β = 0.187, P < 0.05) were independent correlates of depression symptoms.

CONCLUSION

MASLD patients have a high detection rate of anxiety and depression symptoms, which are significantly correlated with multiple metabolic indicators. Obesity, lipid metabolism disorders, and hepatic fat deposition are significantly associated with anxiety and depression symptoms. Clinical practice should emphasize psychological health assessment in MASLD patients and adopt comprehensive intervention measures to improve patients' metabolic status and psychological state.

Keywords: Metabolic dysfunction-associated steatotic liver disease; Anxiety; Depression; Metabolic indicators; Cross-sectional study; Body mass index; Lipid metabolism

Core Tip: This cross-sectional study systematically assesses anxiety and depression symptoms alongside comprehensive metabolic indicators in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We found high rates of psychological symptoms that are significantly associated with key metabolic parameters including body mass index, triglycerides, liver fat content, and liver enzymes. These findings support a multidimensional relationship between mental health and metabolic dysfunction in MASLD and highlight the importance of integrating psychological screening and metabolic management in clinical care to improve overall outcomes. This work provides a basis for more holistic strategies in MASLD patient management.