目的 探讨代谢相关脂肪性肝病（MAFLD）患者中多种异常体质成分（如肌少症、肌脂肪变性、内脏肥胖、骨质疏松）与中重度肝脂肪变性和显著肝纤维化风险的相关性。 方法 回顾性选择2022年6月至2023年6月在我院收治的392例MAFLD成年受试者，根据定量CT评估的肝脏脂肪含量将MAFLD患者分为轻度脂肪变性组（210例）和中重度脂肪变性组（182例）。收集所有受试者的一般资料及血液学指标，并基于人工智能体成分分析技术定量评估体质成分。采用Pearson或Spearman相关性分析探讨体质成分参数与肝脂肪含量之间的相关性。采用多因素logistic回归分析体质成分异常是否为中重度肝脂肪变性和显著肝纤维化的独立危险因素。 结果 中重度肝脂肪变性患者合并肌少症、内脏肥胖及骨质疏松的比例较轻度组升高（P < 0.05）。骨骼肌指数（r = -0.131， P = 0.009）、肌肉密度（r = -0.105， P = 0.038）及骨密度（r = -0.135， P = 0.007）均与肝脂肪含量呈负相关，而肌间脂肪分数（r = 0.121， P = 0.016）、内脏脂肪指数（r = 0.434， P < 0.001）及皮下脂肪指数（r = 0.289， P < 0.001）则呈正相关。矫正多种混杂因素后，骨质疏松（OR = 2.04， 95%CI ： 1.03 ~ 4.03， P = 0.041）、肌少症（OR = 2.19， 95%CI ： 1.37 ~ 3.52， P = 0.001）、内脏肥胖（OR = 1.84， 95%CI ： 1.08 ~ 3.15， P = 0.026）均是中重度肝脂肪变性的独立危险因素；同时，在调整偏倚后，骨质疏松（OR =2.63， 95%CI ： 1.37 ~ 5.05， P = 0.004）、肌少症（OR = 1.94， 95%CI ： 1.28 ~ 2.94， P = 0.002）、内脏肥胖（OR = 2.54， 95%CI ： 1.58 ~ 4.08， P < 0.001）也是显著肝纤维化的独立危险因素。 结论 中重度MAFLD患者易合并肌少症等多种体质成分异常。骨质疏松、肌少症、内脏肥胖不仅是中重度肝脂肪变性的关键独立危险因素，而且增加肝纤维化的发生风险，应尽早识别并采取早期预防和干预。

Objective To explore the association of multiple abnormal body compositions （sarcopenia， myosteatosis， visceral obesity， osteoporosis） with the risks of moderate-to-severe hepatic steatosis and significant liver fibrosis in patients with metabolic associated fatty liver disease （MAFLD）. Methods A retrospective study was conducted in 392 adult patients with MAFLD admitted to our hospital between June 2022 and June 2023. Based on liver fat content assessed by quantitative CT， the MAFLD patients were divided into a mild steatosis group （210 cases） and a moderate-to-severe steatosis group （182 cases）. General information and hematological indicators of all subjects were collected， and body composition was quantitatively evaluated using AI-based body composition analysis technology. Pearson or Spearman correlation analyses were employed to examine relationships between body composition parameters and hepatic fat content. Multivariate logistic regression analysis was used to determine whether abnormal body composition is an independent risk factor for moderate-to-severe hepatic steatosis and significant liver fibrosis. Results Compared to patients with mild hepatic steatosis， those with moderate-to-severe steatosis exhibited significantly higher prevalence of sarcopenia， visceral obesity， and osteoporosis （P < 0.05）. Skeletal muscle index（r = -0.131， P = 0.009）， muscle attenuation（r = -0.105， P = 0.038）， and bone mineral density （r = -0.135 P = 0.007）demonstrated inverse correlations with hepatic fat content， while intermuscular fat fraction（r = 0.121， P = 0.016）， visceral fat index（r = 0.434， P < 0.001）， and subcutaneous fat index（r = 0.289， P < 0.001）showed positive correlations. After adjusting for multiple confounders， osteoporosis（OR = 2.04， 95%CI ： 1.03 ~ 4.03， P = 0.041）， sarcopenia（OR = 2.19， 95%CI ： 1.37 ~ 3.52， P = 0.001）， and visceral obesity（OR = 1.84， 95%CI ： 1.08 ~ 3.15， P = 0.026） were all independent risk factors for moderate-to-severe hepatic steatosis. Additionally， after bias adjustment， osteoporosis（OR = 2.63， 95%CI ： 1.37 ~ 5.05， P = 0.004），sarcopenia（OR =1.94， 95%CI ： 1.28 ~ 2.94， P = 0.002） and visceral obesity（OR = 2.54， 95%CI ： 1.58 ~ 4.08， P < 0.001）were also independent risk factors for significant liver fibrosis. Conclusion Patients with moderate-to-severe MAFLD are predisposed to concurrent body composition abnormalities， including sarcopenia. Importantly，osteoporosis， sarcopenia and visceral obesity are not only key independent risk factors for moderate-to-severe hepatic steatosis， but also significantly increase the risk of liver fibrosis. Early identification， prevention， and intervention should be implemented.