Pancreatic fat accumulation is associated with age, obesity, and metabolic abnormalities. The contributions of individual metabolic and inflammatory measures after mutual adjustment remain unclear. Objective: To assess associations of a calculated semiquantitative pancreatic MRI fat index with clinical, anthropometric, metabolic, and inflammatory measures in adults with met-abolic risk factors. Materials and Methods: This cross-sectional analysis used prospectively collected data from 150 adults aged 30–60 years examined in Astana between 25 October 2025 and 30 April 2026. The MRI fat index was calculated from dual-echo chemical-shift images and was not equivalent to standardized MRI-PDFF. Analyses included Kruskal–Wallis tests, Spearman correlations, multivariable gamma regression, and sensitivity analyses. Multiple comparisons were adjusted using the Benjamini–Hochberg method. Results: The median index was 5.70 [2.60–9.83] %. The strongest positive correlations were with age (ρ=0.445), BMI (ρ=0.426), HbA1c (ρ=0.400), HOMA-IR (ρ=0.385), interleu-kin-6 (ρ=0.368), and insulin (ρ=0.354); HDL cholesterol was inversely correlated (ρ=−0.240). In the full gamma model, only age remained statistically significant, with a mean ratio of 1.510 per standard deviation (95 % CI 1.254–1.818; p<0.001). Associations with sex, BMI, and interleukin-6 reached statistical significance only in the additional linear model. Conclusion: In unadjusted analyses, the MRI fat index was associated with several an-thropometric, metabolic, and inflammatory measures. After mutual adjustment, the association with age was the most consistent. The semiquantitative nature of the index and the depend-ence of other associations on model choice limit the clinical interpretation of these findings

Background/Objectives: To evaluate an exploratory ordinal transabdominal ultrasonography score against a study-defined semiquantitative two-echo chemical-shift MRI pancreatic fat index ≥ 5%. Methods: This prospective paired diagnostic accuracy study included 150 adults aged 30–60 years with metabolic abnormalities or risk factors and technically adequate ultrasonography. A score ≥ 1 was the primary positive index-test result. Diagnostic accuracy, ROC AUC, and ordinal correspondence were evaluated. Results: After nine clinical exclusions, pancreatic ultrasonography was technically evaluable in 150 of 170 participants (88.2%; 95% CI, 82.5–92.3%). For the study-defined MRI index ≥ 5%, sensitivity was 76.8% (95% CI, 66.6–84.6%), specificity was 77.9% (95% CI, 66.7–86.2%), accuracy was 77.3% (95% CI, 70.0–83.3%), and AUC was 0.812 (95% CI, 0.748–0.876). Exact four-category agreement was 45.3%, and quadratically weighted kappa was 0.504 (95% CI, 0.387–0.612). Conclusions: These estimates describe agreement and discrimination relative to the study-defined two-echo MRI index in selected adults with metabolic risk and technically adequate ultrasonography. They should not be interpreted as diagnostic accuracy for histologically confirmed pancreatic steatosis or standardized MRI-PDFF-defined disease. The exploratory score is not a quantitative substitute for MRI and requires reproducibility assessment and external validation.