Validation of simple indexes for nonalcoholic fatty liver disease in western China: a retrospective cross-sectional study

Zhu, Jinzhou; He, Mingqing; Zhang, Yong; Li, Tingxin; Liu, Yuping; Xu, Zhiye; Chen, Weichang

doi:10.1507/endocrj.ej17-0466

Cited by 32 publications

(30 citation statements)

References 33 publications

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“…This potentially could have led to diagnostic misclassification. Validation studies of the FLI in other Chinese populations have reported areas under the receiver operating curve (AUROC) ranging from 0.76 to 0.88, but given that we used a higher FLI cut‐off value than that recommended for the Chinese population, we expect to have smaller misclassification bias. Furthermore, because our study population is relatively ethnically homogeneous (Han Chinese), we anticipate a higher AUROC of the FLI in this analysis.…”

Section: Discussionmentioning

confidence: 98%

Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population‐Based Study

et al. 2019

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Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of liver disease worldwide and has emerged as a significant public health concern in China. A better understanding of the etiology of NAFLD can inform effective management strategies for this disease. We examined factors associated with NAFLD in two districts of Hangzhou, China, focusing on the relationship of regional body fat distribution, muscle mass, and NAFLD. We used baseline data to carry out a cross‐sectional analysis among 3,589 participants from the Wellness Living Laboratory (WELL) China study, a longitudinal population‐based study that aims to investigate and promote well‐being among the Chinese population. NAFLD was defined using the widely validated fatty liver index (FLI). Multivariate logistic regressions were performed to assess independent associations between NAFLD and metabolic risk factors (e.g., insulin resistance) and dual x‐ray absorptiometry (DXA)‐derived measures (e.g., android fat ratio [AFR] and skeletal muscle index [SMI]). Of the 3,589 participants, 476 (13.3%) were classified as having FLI‐defined NAFLD (FLI ≥60). Among those, 58.0% were men. According to our analysis, AFR (odds ratio [OR], 10.0; 95% confidence interval [CI], 5.8‐18.5), insulin resistance (OR, 4.0; 95% CI, 3.0‐5.3), high alanine aminotransferase levels (OR, 7.6; 95% CI, 5.8‐10.0), smoking (OR, 2.0; 95% CI, 1.4‐3.0), and male sex (OR, 2.9; 95% CI, 2.0‐4.2) were positively associated with NAFLD risk, while SMI (OR, 0.1; 95% CI, 0.07‐0.13) was inversely associated with NAFLD risk. Conclusion: In addition to known metabolic risk factors, DXA‐derived AFR and SMI may provide additional insights to the understanding of NAFLD. Interventions that aim to decrease AFR and increase SMI may be important to reduce the burden of NAFLD in this population.

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Section: Discussionmentioning

confidence: 98%

Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population‐Based Study

et al. 2019

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“…In addition, this quantitative US model could improve the reliability and reproducibility in comparison with conventional US, when it is standardized by a tissue-mimicking phantom, while these findings are needed to verify in further studies[49]. Above all, US is still recommended for diagnosing moderate and severe steatosis in current guideline[44].…”

Section: Diagnosis Of Nafldmentioning

confidence: 99%

Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice

Zhou

Cai

She

et al. 2019

WJG

189

194

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With the increasing number of individuals with diabetes and obesity, nonalcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent, affecting one-quarter of adults worldwide. The spectrum of NAFLD ranges from simple steatosis or nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH). NAFLD, especially NASH, may progress to fibrosis, leading to cirrhosis and hepatocellular carcinoma. NAFLD can impose a severe economic burden, and patients with NAFLD-related terminal or deteriorative liver diseases have become one of the main groups receiving liver transplantation. The increasing prevalence of NAFLD and the severe outcomes of NASH make it necessary to use effective methods to identify NAFLD. Although recognized as the gold standard, biopsy is limited by its sampling bias, poor acceptability, and severe complications, such as mortality, bleeding, and pain. Therefore, noninvasive methods are urgently needed to avoid biopsy for diagnosing NAFLD. This review discusses the current noninvasive methods for assessing NAFLD, including steatosis, NASH, and NAFLD-related fibrosis, and explores the advantages and disadvantages of measurement tools. In addition, we analyze potential noninvasive biomarkers for tracking disease processes and monitoring treatment effects, and explore effective algorithms consisting of imaging and nonimaging biomarkers for diagnosing advanced fibrosis and reducing unnecessary biopsies in clinical practice.

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“…It has been validated to a great extent and has been proved to be correlated with insulin resistance, coronary heart disease, and early atherosclerosis [27,28]. Studies have shown that FLI has a moderate discrimination (AUC, 0.83-0.88) in Taiwan, northern and western Chinese mainland [17,29,30]. Our study has testi ed the feasibility of FLI in eastern Chinese mainland and proved that FLI has good applicability in the community population.…”

Section: Discussionmentioning

confidence: 68%

“…ZJU was developed based on BMI, FPG, TG, ALT to AST ratio and gender with an AUC of 0.82 in eastern China, and in the validation cohort using pathological data, the ZJU index had a good accuracy (AUC, 0.896) for the detection of steatosis [15]. Some recent studies have validated ZJU and compared to other models including FLI using large population, with con icting results [29,31]. The underlying reason may be the difference of NAFLD prevalence and characteristics of population.…”

Section: Discussionmentioning

confidence: 99%

External Validation and Comparison of Simple Tools to Screen for Nonalcoholic Fatty Liver disease in Chinese community population

Zhang¹,

Wang²,

Wang³

et al. 2020

Preprint

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Background: Various non-invasive tools based on anthropometric indicators, blood lipids, and liver enzymes, etc. have been developed to screen for nonalcoholic fatty liver disease (NAFLD), with different diagnostic performance and cut-off values among studies. We aimed to validate and compare eight NAFLD-related models developed by simple indicators and to define their cut-off values in Chinese community population.Methods: A cross-sectional study was conducted in a health examination cohort of 3259 people. NAFLD was diagnosed by ultrasonography. General, anthropometric and biochemical data were collected. Fatty liver index (FLI), fatty liver disease index (FLD), Zhejiang University index (ZJU), lipid accumulation product (LAP), regression formula of controlled attenuation parameter (CAP), waist-to-height ratio (WHtR), triglyceride and glucose index (TyG), and visceral adiposity index (VAI) were calculated. The accuracy and cut-off points to detect NAFLD were evaluated by area under the receiver operator characteristic curve (AUROC) and the maximum Youden index analysis, respectively. A head-to-head comparison between these models and Decision Curve Analysis were conducted.Results: All of eight models are significant in different degrees of NAFLD. In 8 noninvasive diagnostic models of NAFLD, AUCs of FLI and FLD for NAFLD were higher than those of other models in the whole (0.852 and 0.852), male (0.826 and 0.824), and female (0.897 and 0.888) population, respectively. Decision Curve Analysis showed that FLI, FLD and ZJU have higher net benefit to screen for NAFLD compared to other models. The cut-off points of FLI and FLD for NAFLD were different in the total (20.6 and 28.7), male (25.3 and 29.0), and female (8.4 and 26.1) population.Conclusions: FLI and FLD could be the most accurate and applicable of 8 models for the noninvasive diagnosis of NAFLD in both male and female groups.

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Validation of simple indexes for nonalcoholic fatty liver disease in western China: a retrospective cross-sectional study

Cited by 32 publications

References 33 publications

Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population‐Based Study

Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population‐Based Study

Noninvasive evaluation of nonalcoholic fatty liver disease: Current evidence and practice

External Validation and Comparison of Simple Tools to Screen for Nonalcoholic Fatty Liver disease in Chinese community population

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