Pericardial fat pad detected on chest X-ray is closely associated with metabolic dysfunction-associated steatotic liver disease and visceral fat accumulation in patients with type 2 diabetes

Aim: This study aimed to evaluate whether a pericardial fat pad (PFP) detected on chest X-ray can estimate metabolic dysfunction-associated steatotic liver disease (MASLD) and visceral fat accumulation. Methods: Sixty-six patients with type 2 diabetes were categorized on the basis of the presence (n = 40) or absence (n = 26) of PFP on chest X-ray. The visceral fat area (VFA) and visceral-to-subcutaneous fat area ratio (V/S) at the umbilical level were assessed using abdominal computed tomography, whereas the controlled attenuation parameter (CAP) was measured using FibroScan. The fatty liver index (FLI) was estimated using clinical parameters, including body mass index (BMI), blood pressure, and biochemical markers. Results: Subjects with PFP had a significantly higher BMI and a higher proportion of males. Subjects with PFP demonstrated significantly higher CAP, FLI, VFA, and V/S than those without PFP (P = 0.018, 0.005, < 0.001, and 0.020, respectively). The cutoff values for detecting PFP on chest X-ray were CAP ≥265.5 dB/m, FLI ≥ 30.6, VFA ≥ 118.7 cm², and V/S ≥ 0.71. Conclusions: In patients with type 2 diabetes, PFP detected on chest X-ray may serve as an indicator of MASLD and visceral fat accumulation.