Health Psychology Research / HPR / Online First / DOI: 10.14440/hpr.0207
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RESEARCH ARTICLE

Associations between Eating Behaviors, Body Composition, and Mental Health in Asian and White Adults with Metabolic Dysfunction-associated Steatotic Liver Disease

Kelly A. Scheneman1* ,  Steven Cen2 ,  Brian Xu3 ,  Lauren Bennett1 ,  Tse-Ling Fong3
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1 Pickup Family Neurosciences Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California 92663, United States of America
2 Department of Radiology/Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States of America
3 Digestive Health Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California 92663, United States of America
HPR, e81240047 https://doi.org/10.14440/hpr.0207
Submitted: 20 July 2025 | Revised: 9 November 2025 | Accepted: 26 November 2025 | Published: 19 December 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is affected by metabolic, psychological, and behavioral factors, with potential differences in pathophysiological pathways across racial groups.

Objective

This study aims to investigate the relationship between eating behaviors, emotional functioning, and anthropometric differences in Asian and maintain at various stages of liver disease.

Methods

A retrospective analysis was conducted on 98 MASLD patients (70 White and 28 Asian) from a Southern California liver clinic. Participants completed validated questionnaires assessing depressive and anxiety symptoms, eating behaviors, and quality of life. Body composition was measured using bioelectrical impedance analysis, and liver health was assessed through transient elastography. Multivariate regression and mediation analyses examined associations and pathways among psychological, behavioral, and clinical variables, with race as a moderator.

Results

White participants had higher body mass index (BMI) and body fat percentage, but liver steatosis and stiffness were similar between groups. In Asians, hepatic steatosis correlated most strongly with body fat mass, whereas in Whites, emotional eating was more closely linked to BMI and body fat percentage compared to Asians. Whites reported higher anxiety and lower quality of life. Emotional eating was associated with hepatic steatosis in both groups, but only in Whites did BMI and percent body fat mediate this relationship. Among Asians, emotional eating was linked to liver fat independent of body composition.

Conclusion

Distinct racial pathways exist in MASLD progression, with Asians potentially developing fatty liver without overt body fat changes. These findings highlight the need for tailored diagnostic and clinical strategies that consider metabolic, behavioral, and psychological differences across racial groups.

Keywords
Fatty liver
Body composition
Eating behaviors
Mental health
Anthropometric differences
Emotional eating
Funding
This work was supported by the Liver Program Research Fund, Hoag Foundation.
Conflict of interest
The authors have no conflicts of interest to disclose.
References
  1. Chan WK, Chuah KH, Rajaram RB, Lim LL, Ratnasingam J, Vethakkan SR. Metabolic dysfunc­tion-associated steatotic liver disease (MASLD): A state-of-the-art review. J Obes Metab Syndr. 2023;32(3):197-213. doi: 10.7570/jomes23052

 

  1. Lekakis V, Papatheodoridis G. Natural his­tory of metabolic dysfunction-associated stea­totic liver disease. Eur J Intern Med. 2023;122:3-10. doi: 10.1016/j.ejim.2023.11.005

 

  1. Jiménez-Ramos M, Kendall TJ, Drozdov I, Fallowfield JA. A data-driven approach to decode metabolic dysfunction-associated steatotic liver disease. Ann Hepatol. 2023;29(2):101278. doi: 10.1016/j.aohep.2023.101278

 

  1. Gill M, Majumdar A. Metabolic associated fatty liver disease: Addressing a new era in liver trans­plantation. World J Hepatol. 2020;12(12):1168-1181. doi: 10.4254/wjh.v12.i12.1168

 

  1. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clin­ical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi: 10.1016/j.jhep.2024.04.031

 

  1. Macavei B, Baban A, Dumitrascu DL. Psychological factors associated with NAFLD/NASH: A systematic review. Eur Rev Med Pharmacol Sci. 2016;20(24):5081-5097.

 

  1. Shea S, Lionis C, Kite C, et al. Non-alcoholic fatty liver disease (NAFLD) and potential links to depression, anxiety, and chronic stress. Biomedicines. 2021;9(11):1697. doi: 10.3390/ biomedicines9111697

 

  1. Sherif ZA, Saeed A, Ghavimi S, et al. Global epidemiology of nonalcoholic fatty liver disease and perspectives on US minority populations. Dig Dis Sci. 2016;61:1214-1225. doi: 10.1007/ s10620-016-4143-0

 

  1. Soto-Angona Ó, Anmella G, Valdés-Florido MJ, et al. Non-alcoholic fatty liver disease (NAFLD) as a neglected metabolic companion of psychi­atric disorders: Common pathways and future approaches. BMC Med. 2020;18:261. doi: 10.1186/ s12916-020-01713-8

 

  1. Shea S, Lionis C, Kite C, et al. Non-alcoholic fatty liver disease and coexisting depression, anx­iety, and/or stress in adults: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024;15:1357664. doi: 10.3389/fendo.2024.1357664

 

  1. Elwing JE, Lustman PJ, Wang HL, Clouse RE. Depression, anxiety, and nonalcoholic steato­hepatitis. Psychosom Med. 2006;68(4):563-569. doi: 10.1097/01.psy.0000221276.17823.df

 

  1. Zhang S, Ma C, Wang X, et al. Impact of chronic psychological stress on nonalcoholic fatty liver dis­ease. Int J Clin Exp Med. 2019;12(7):7991-7998.

 

  1. Funuyet-Salas J, Pérez-San-Gregorio MA, Martín-Rodríguez A, Romero-GómezM. Psychological biomarkers and fibrosis: An innovative approach to non-alcoholic fatty liver disease. Front Med. 2020;7:585425. doi: 10.3389/fmed.2020.585425

 

  1. Brodosi L, Stecchi M, Marchignoli F, et al. Risk of binge eating disorder in patients with meta­bolic dysfunction-associated steatotic liver dis­ease. Eat Weight Disord. 2023;28:100. doi: 10.1007/ s40519-023-01628-2

 

  1. Khalashte AA, Zhachemuk SK, Lyalyukova EA, Zhernakova GN. Eating behavior in patients with metabolically associated fatty liver disease. Exp Clin Gastroenterol. 2023;218(10):104- 113. doi: 10.31146/1682-8658-ecg-218-10-104-113

 

  1. Wong RJ, Cheung R, Ahmed A. Nonalcoholic steatohepatitis is the most rapidly growing indi­cation for liver transplantation in patients with hepatocellular carcinoma in the U.S. Hepatology. 2014;59(6):2188-2195. doi: 10.1002/hep.26986

 

  1. Fan JG, Kim SU, Wong VW. New trends on obesity and NAFLD in Asia. J Hepatol. 2017;67(4):862-873. doi: 10.1016/j.jhep.2017.06.003

 

  1. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing general­ized anxiety disorder: The GAD-7. Arch Intern Med. 2006;166(10):1092-1097. doi: 10.1001/ archinte.166.10.1092

 

  1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi: 10.1046/j.1525-1497.2001.016009606.x

 

  1. Karlsson J, Persson LO, Sjöström L, Sullivan M. Psychometric properties and factor structure of the three-factor eating questionnaire (TFEQ) in obese men and women. Results from the Swedish obese subjects (SOS) study. Int J Obes Relat Metab Disord. 2000;24(12):1715-1725. doi: 10.1038/sj.ijo.0801442

 

  1. Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233. doi: 10.1097/00005650-199603000-00003

 

  1. Kliemann N, Beeken RJ, Wardle J, Johnson F. Development and validation of the self-regula­tion of eating behaviour questionnaire for adults. Int J Behav Nutr Phys Act. 2016;13:87. doi: 10.1186/ s12966-016-0414-6

 

  1. Anglé S, Engblom J, Eriksson T, et al. Three factor eating questionnaire-R18 as a measure of cognitive restraint, uncontrolled eating and emotional eating in a sample of young Finnish females. Int J Behav Nutr Phys Act. 2009;6:41. doi: 10.1186/1479-5868-6-41

 

  1. Eddowes PJ, Sasso M, Allison M, et al. Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019;156(6):1717-1730. doi: 10.1053/j.gastro.2019.01.042

 

  1. Hurt RT, Ebbert JO, Croghan I, et al. The com­parison of segmental multifrequency bioelectrical impedance analysis and dual-energy x-ray absorp­tiometry for estimating fat free mass and percent­age body fat in an ambulatory population. JPEN J Parenter Enteral Nutr. 2021;45(6):1231-1238. doi: 10.1002/jpen.1994

 

  1. Hayes AF, Rockwood NJ. Conditional pro­cess analysis: Concepts, computation, and advances in the modeling of the contingencies of mechanisms. Am Behav Sci. 2020;64(1):19-54. doi: 10.1177/0002764219859633

 

  1. Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3:141-146. doi: 10.1046/j.1467-789X.2002.00065.x

 

  1. Wulan SN, Westerterp KR, Plasqui G. Ethnic dif­ferences in body composition and the associated met­abolic profile: A comparative study between Asians and Caucasians. Maturitas. 2010;65(4):315-319. doi: 10.1016/j.maturitas.2009.12.012

 

  1. Botacin EC, Duarte SMB, Stefano JT, Barbosa MED, Pessoa MG, Oliveira CP. Association between anxiety and depression in metabolic dysfunction-associated steatotic liver disease (MASLD). Arq Gastroenterol. 2024;61:e23128. doi: 10.1590/S0004-2803.24612023-128

 

  1. Islam JY, Parikh NS, Lappen H, Venkat V, Nalkar P, Kapadia F. Mental health burdens among North American Asian adults living with chronic conditions: A systematic review. Epidemiol Rev. 2023;45:82-92. doi: 10.1093/epirev/mxad003

 

  1. Chowdhury PP, Balluz LS, Strine TW. Health-related quality of life among minority populations in the United States, BRFSS 2001-2002. Ethn Dis. 2008;18(4):483-487. doi: 10.1186/1048-6694-15-63

 

  1. Chentha AK, Sreeja TM, Hanno R, Madhavi S, Gandrapu BBN. A review of the association between obesity and depression. Int J Biol Med Res. 2013;4(3):3520-3522.

 

  1. De Wit LM, Luppino F, Van Straten A, Penninx B, Zitman FG, Cuijpers P. Depression and obesity: A meta-analysis of community-based studies. Psychiatry Res. 2010;178:230-235. doi: 10.1016/j.psychres.2009.04.015

 

  1. Preiss K, Brennan L, Clarke D. A systematic review of variables associated with the relation­ship between obesity and depression. Obes Rev. 2013;14(11):906-918. doi: 10.1111/obr.12052

 

  1. Blasco BV, García-Jiménez JJ, Bodoano, I, Gutiérrez-Rojas, L. Obesity and depression: Its prevalence and influence as a prognostic fac­tor: A systematic review. Psychiatry Investig. 2020;17:715-724. doi: 10.30773/pi.2020.0099

 

  1. Barry DT, Grilo CM. Eating and body image disturbances in adolescent psychiatric inpatients: Gender and ethnicity patterns. Int J Eat Disord. 2002;32(3):335-343. doi: 10.1002/eat.10082

 

  1. White MA, Grilo CM. Ethnic differences in the prediction of eating and body image disturbances among female adolescent psychiatric inpatients. Int J Eat Disord. 2005;38(1):78-84. doi: 10.1002/ eat.20157

 

  1. Le Grange D, Hughes EK, Court A, Yeo M, Crosby RD, Sawyer SM. Randomized clinical trial of parent-focused treatment and family-based treatment for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 2016;55(8):683-692. doi: 10.1016/j.jaac.2016.05.007
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Health Psychology Research, Electronic ISSN: 2420-8124 Published by Health Psychology Research
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