Accuracy of Non-invasive Indices for Diagnosing Hepatic Steatosis Compared to Imaging in a Real-World Cohort

Editorial: clinical outcomes in lean NAFLD – the devil is in the details. Authors' reply

“…Third, Tan et al point out that some lean patients with NAFLD may have died of unrelated diseases due to a higher burden of comorbidities. We agree with this point, which is especially relevant since patients with comorbidities may have been more likely to undergo imaging resulting in a NAFLD diagnosis 5 . We addressed this question via a sensitivity analysis adjusting for Charlson comorbidity index, a commonly used score to quantify disease burden, and lean body mass index remained associated with higher mortality.…”

“…3,4 This approach inevitably includes a high proportion of patients with incidental diagnoses of NAFLD: we previously found that the most common indication for abdominal imaging in our centre was abdominal pain or other abdominal symptoms (44%) which are unlikely to be caused by NAFLD. 5 Tan et al correctly point out several limitations of our study. First, our study was based out of a single medical centre, though we included the entire spectrum of care from primary care through subspecialty care.…”

“…We used this approach with the aim of identifying consecutive patients with objective evidence of hepatic steatosis and to avoid referral biases inherent in cohorts based in subspecialty clinics who typically have more advanced disease 3,4 . This approach inevitably includes a high proportion of patients with incidental diagnoses of NAFLD: we previously found that the most common indication for abdominal imaging in our centre was abdominal pain or other abdominal symptoms (44%) which are unlikely to be caused by NAFLD 5 …”

“…We agree with this point, which is especially relevant since patients with comorbidities may have been more likely to undergo imaging resulting in a NAFLD diagnosis. 5 We addressed this question via a sensitivity analysis adjusting for Charlson comorbidity index, a commonly used score to quantify disease burden, and lean body mass index remained associated with higher mortality. However, we acknowledge the risk of residual confounding, especially with diseases that are not included in the Charlson comorbidity index.…”

Effects of social determinants of health on mortality and incident liver‐related events and cardiovascular disease in steatotic liver disease

“…MASLD was defined as hepatic steatosis on imaging identified based on a validated natural language processing algorithm, 12 plus either type 2 diabetes, overweight (BMI ≥25 kg/m 2 ) or two of dyslipidaemia, hypertension and pre‐diabetes (Table S1). 13,14 We also excluded patients with a diagnosis code for baseline malignancy other than non‐melanoma skin cancer because at our medical centre malignancy is a common indication for imaging diagnoses of hepatic steatosis and is associated with high short‐term mortality 15 . The index date was defined as the first date of imaging showing hepatic steatosis.…”