Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent among individuals with obesity, while accessible non-invasive tools for risk assessment remain limited. This study evaluated the associations between body composition parameters and biochemical indices of hepatic steatosis and fibrosis in women. Material and methods: A cross-sectional retrospective analysis was performed in 1492 adults with overweight or obesity, including 1164 women. Anthropometric and bioelectrical impedance analysis (BIA) measurements, including percent body fat (PBF) and visceral fat rating (VFR), were collected along with serum indices: Aspartate Aminotransferase to Platelet Ratio Index (APRI), Fibrosis-4 Index (FIB-4), BARD (BMI, AST/ALT ratio, and diabetes), lipid accumulation product (LAP), De Ritis ratio (AST/ALT), triglyceride-to-HDL-cholesterol ratio (TG/HDL), and neutrophil count-to-HDL ratio (NEU/HDL). Associations were assessed using rank-biserial correlations and linear regression. Results: Women with elevated FIB-4 (> 1.3) had significantly higher VFR, PBF, WC, and BMI. VFR showed a positive correlation with FIB-4 (r = 0.32, p < 0.001) and was the strongest predictor in regression analysis (β = 0.88, p < 0.001). WC was the primary predictor for LAP, ALT, AST, and TG/HDL, while PBF demonstrated weaker and inconsistent relationships. BMI did not significantly predict any hepatic indices. Conclusions: Indicators of visceral adiposity, particularly VFR and WC, were more strongly associated with markers of hepatic steatosis and fibrosis than general adiposity measures such as PBF or BMI. These findings suggest that BIA-derived VFR may serve as a practical, accessible tool for early MASLD risk stratification in women, supporting timely clinical intervention. Keywords: Body composition parametersFIB-4obesityliver steatosis