Application of a Novel Prediction Model for Predicting 2-Year Risk of Non-Alcoholic Fatty Liver Disease in the Non-Obese Population with Normal Blood Lipid Levels: A Large Prospective Cohort Study from China

Abstract

Purpose The purpose of this study was to develop and validate a nomogram to better assess the 2-year risk of non-alcoholic fatty liver disease (NAFLD) in non-obese population with normal blood lipid levels. Patients and Methods This study was a secondary analysis of a prospective study. We included 3659 non-obese adults with normal blood lipid levels without NAFLD at baseline. A total of 2744 participants were included in the development cohort and 915 participants were included in the validation cohort. The least absolute contraction selection operator (LASSO) regression model was used to identify the best risk factors. Multivariate Cox regression analysis was used to construct the prediction model. The performance of the prediction model was assessed using Harrell’s consistency index (C-index), area under the receiver operating characteristic (AUROC) curve and calibration curve. Decision curve analysis was applied to evaluate the clinical usefulness of the prediction model. Results After LASSO regression analysis and multivariate Cox regression analysis on the development cohort, BMI, TG, DBIL, ALT and GGT were found to be risk predictors and were integrated into the nomogram. The C-index of development cohort and validation cohort was 0.819 (95% CI, 0.798 to 0.840) and 0.815 (95% CI, 0.781 to 0.849), respectively. The AUROC of 2-year NAFLD risk in the development cohort and validation cohort was 0.831 (95% CI, 0.811 to 0.851) and 0.797 (95% CI, 0.765 to 0.829), respectively. From calibration curves, the nomogram showed a good agreement between predicted and actual probabilities. The decision curve analysis indicated that application of the nomogram is more effective than the intervention-for-all-patients scheme. Conclusion We developed and validated a nomogram for predicting 2-year risk of NAFLD in the non-obese population with normal blood lipid levels.

Dose-Response Associations of Metabolic Score for Insulin Resistance Index with Nonalcoholic Fatty Liver Disease among a Nonobese Chinese Population: Retrospective Evidence from a Population-Based Cohort Study

“…First, IR performs a critical role in the development of NAFLD [ 39 , 40 ]. METS-IR can be considered an independent predictor of IR [ 28 ]. As TG levels increase and HDL-C levels decrease, free fatty acids will increase with lipolysis [ 41 ].…”

“…The diagnosis of NAFLD is made according to previously published diagnostic guidelines [ 27 ]. Briefly, the diagnostic criteria are to meet two of the following five abnormal echoes on abdominal ultrasonography, the first of which is essential for diagnosis: (1) diffuse hyperechogenicity relative to the spleen and kidney, (2) reduced visibility of detailed structures within the liver, (3) mild to moderate enlargement of the liver with bluntly rounded margins, (4) diminished hepatic blood flow signal with normal blood flow distribution, and (5) poorly defined or incomplete display of the right hepatic lobe and diaphragmatic envelope [ 27 , 28 ]. METS-IR was calculated as (ln ((2 × FPG) + TG) × BMI)/(ln (HDL‐C)) [ 29 ].…”

Associations Between the Metabolic Score for Insulin Resistance Index and the Risk of Type 2 Diabetes Mellitus Among Non-Obese Adults: Insights from a Population-Based Cohort Study

“…14 Thus, non-obese diabetes may have underlying pathophysiological changes that may lead to a worse prognosis than obese diabetes. 11,15 However, the possible mechanisms explaining this phenomenon remain to be elucidated.…”

Hepatic Steatosis Index and the Risk of Type 2 Diabetes Mellitus in China: Insights from a General Population-Based Cohort Study

“…Currently, the most common cause of liver disease worldwide is nonalcoholic fatty liver disease (NAFLD) [9,10]. The development of NAFLD is strongly related to adverse lifestyle choices, insulin resistance, metabolic syndrome, and visceral obesity [11][12][13]. NAFLD is a robust independent risk factor for T2DM, according to an increasing body of research [14,15].…”