Association between depression and metabolic dysfunction-associated steatotic liver disease: a cross-sectional analysis from the paracelsus 10,000 Study

Background and aims: Depression is linked to obesity and metabolic syndrome, but its independent association with metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear. We examined the association between depressive symptoms and MASLD, independent of other risk factors. Methods: We analyzed cross-sectional data from 7433 participants of the Paracelsus 10,000 study. Depression (BDI-II > 13) and MASLD (FLI ≥ 60 plus ≥ 1 cardiometabolic risk factor) were assessed. Associations were examined using Poisson and linear regression models adjusted for demographics, lifestyle factors, metabolic syndrome, and antidepressant use. Subgroup and interaction analyses explored effect modification. Results: MASLD was more prevalent in participants with depressive symptoms than those without (37% vs. 27%, p < 0.01). Depressive symptoms were independently associated with MASLD (adjusted incidence rate ratio: 1.25, 95% CI: 1.13–1.39, p < 0.01), with consistent findings using continuous BDI-II scores. The association remained robust across subgroups defined by age, metabolic syndrome, education, smoking status, and antidepressant use. No significant differences were observed in fibrosis markers (APRI and FIB-4). Conclusion: In this large, population-based cross-sectional study, depressive symptoms were found to be associated with MASLD, independent of metabolic risk factors and antidepressant use. However, given the observational design and limited detail on antidepressant type, dose, indication, and adherence, the findings should be interpreted with caution and do not support causal conclusions. Nevertheless, findings suggest that mental health considerations may be relevant in MASLD screening and prevention strategies. Further research is needed to explore whether and how antidepressant therapy may relate to liver health.