The ZJU index is a powerful surrogate marker for NAFLD in severely obese North American women

Abstract

IntroductionNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the western world and is highly associated with multiple cardiometabolic complications. The Zhejiang University (ZJU) index was first developed to predict NAFLD in Chinese populations, where it was shown to have better predictive value than other currently used indices. The aims of the present study were to 1) determine the diagnostic accuracy of ZJU index in identifying NAFLD in a well-phenotyped cohort of obese middle-aged American women and 2) compare its performance with other non-invasive indices for NAFLD identification.MethodsTo achieve this goal, we performed a retrospective analysis of a prospectively-collected cohort of participants enrolled in a weight loss trial for severe obesity (RENEW, clinicaltrials.gov identifier: NCT00712127). One hundred and seven women between the age of 30 and 55 with obesity class II (BMI 35–39.9 kg/m2) or class III (BMI ≥ 40 kg/m2) were recruited for analyses. Hepatic steatosis was measured using liver/spleen attenuation ratio (L/S ratio) from unenhanced abdominal computed tomography. Beside ZJU index, hepatic steatosis index (HSI), lipid accumulation production index (LAPI), and visceral adiposity index (VAI) were also determined and to compare their performance in predicting NAFLD.ResultsOf 107 obese women in the study, 40 (37.4%) met imaging criteria for NAFLD using cut-off value of L/S ratio < 1.1. The ZJU index was positively correlated with HIS, LAPI, but not VAI. The area under the curve was highest for the ZJU index (AUC = 0.742, 95% CI:0.647–0.837), followed by HSI (AUC = 0.728, 95% CI:0.631–0.825), LAPI (AUC = 0.682, CI:0.583–0.781), and VAI (AUC = 0.621, 95% CI:0.518–0.725), respectively, using the Youden method.ConclusionThe ZJU index is a powerful surrogate marker for NAFLD in severely obese western females and its predictive value was better than that of other commonly used indices for predicting NAFLD. Our study is the first to suggest that the ZJU index could be a promising model for use in western as well as Chinese populations.

The Visceral Adiposity Index in Non-Alcoholic Fatty Liver Disease and Liver Fibrosis—Systematic Review and Meta-Analysis

“…Of these articles, thirty-one were excluded with reasons as follows: (1) eleven articles were conference abstracts [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], (2) three articles were letters, editorials, and notes [ 45 , 46 , 47 ], (3) four did not involve NAFLD patients [ 48 , 49 , 50 , 51 ], (4) two studies involved HIV patients [ 52 , 53 ], (6) one study involved patients with gastroenteropancreatic neuroendocrine tumors [ 54 ], (7) two studies involved patients with polycystic ovarian syndrome [ 51 , 55 ], (8) six were interventional studies [ 56 , 57 , 58 , 59 , 60 , 61 ], and (9) two articles were published in Chinese and Portuguese [ 62 , 63 ]. The total number of articles included in the qualitative synthesis was twenty-four studies, out of which twenty-two studies were included in the quantitative synthesis [ 36 , 42 , 44 , 55 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ,…”

“…Moreover, two studies used both [ 69 , 72 ]. Finally, one study used abdominal CT according to the liver/spleen attenuation ratio [ 71 ], and one study used proton magnetic resonance spectroscopy (H-MRS) in combination with steatosis biomarkers [ 74 ].…”

“…The VAI was evaluated in a total of fourteen studies comparing values in NAFLD patients with control subjects [ 44 , 65 , 67 , 68 , 70 , 71 , 74 , 76 , 77 , 78 , 80 , 81 , 82 , 83 ]. Figure 2 summarizes the obtained meta-analysis results.…”

“…Considerable heterogeneity was reported with an I 2 = 99% and a p -value < 0.001. Moreover, subgroup analysis was conducted in adults [ 44 , 65 , 67 , 68 , 70 , 71 , 74 , 77 , 78 , 80 , 82 , 83 ] and pediatrics [ 76 , 81 ] separately, with an MD of 1.1227 (95% CI 0.584–1.869) with considerable heterogeneity (I 2 = 98.83% and a p -value < 0.001), and an MD of 0.443 (95% CI -0.052–0.938) with substantial heterogeneity (I 2 = 56.26% and a p -value = 0.131), respectively.…”

Dose–response association of the ZJU index and fatty liver disease risk: A large cohort in China

“…Up to now, most of the studies related to the ZJU index and FLD are cross-sectional studies. 14,15,49 Only one cohort study 50 was conducted in American obesity women. To our knowledge, this is the first longitudinal study identifying the association between the ZJU index and the risk of FLD in China.…”