Published online Apr 27, 2020. doi: 10.4254/wjh.v12.i4.149
Peer-review started: December 20, 2019
First decision: January 6, 2020
Revised: March 16, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 27, 2020
Non-alcoholic fatty liver disease (NAFLD) is a common disorder, with an estimated prevalence ranging from 20% to 35% in the general population. Several scores based on easily measurable biochemical and clinical parameters, including the fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), and NAFLD liver fat score (LFS), have been developed for the detection of NAFLD. However, comparative information regarding the efficacy of these scores for predicting NAFLD in population-based samples comprising normal and high-risk individuals is lacking.
To evaluate four NAFLD detection scores in two samples with different NAFLD risks.
NAFLD screening was performed in a population-based sample of 50-year-old individuals in Uppsala, Sweden [n = 310; Prospective investigation of obesity, energy and metabolism (POEM) study] and a high-risk population comprising patients with a body mass index > 25 kg/m2 and either high plasma triglycerides (≥ 1.7 mmol/L) or type 2 diabetes (n = 310; EFFECT studies). NAFLD was defined as liver fat > 5.5% using magnetic resonance imaging-proton density fat fraction. FLI, HSI, LAP, and NAFLD LFS were assessed. A logistic regression model was used to evaluate the effectiveness of the different scores.
The prevalence of NAFLD was 23% in POEM. FLI showed the highest receiver operating characteristic area under the curve (ROC AUC; 0.82) and was significantly better than the LAP score (P = 0.005 vs LAP, P = 0.08 vs LFS, P = 0.12 vs HSI) for detection of NAFLD. The other three indices performed equally in POEM (0.77-0.78). The prevalence of NAFLD was 74% in EFFECT; LFS performed best (ROC AUC 0.80) in this sample. The ROC AUC for LFS (0.80) was significantly higher than that for FLI (P = 0.0019) and LAP (P = 0.0022), but not HSI (P = 0.11). We performed a sensitivity analysis with stratification for the two high-risk subgroups (patients with diabetes or hypertriglyceridemia) from the EFFECT studies. LAP performed best in patients with hypertriglyceridemia. No major differences were observed between the other scores.
The four investigated NAFLD scores performed differently in the populationbased vs high-risk setting. FLI was preferable in the population-based setting, while LFS performed best in the high-risk setting.
Core tip: Several non-invasive indices based on routinely available biochemical and physical parameters have been developed for the detection of non-alcoholic fatty liver (NAFLD) disease. However, data comparing the efficacy of these indices within a population-based sample are lacking. Here we compared four non-invasive indices, namely, fatty liver index, lipid accumulation product, hepatic steatosis index, and liver fat score, in a population-based (Prospective investigation of obesity, energy and metabolism study) sample and a high-risk (EFFECT studies) sample. Our study demonstrated differences in NAFLD detection between the scores in the two samples. Of the four evaluated scores, fatty liver index was preferable in the population-based sample (NAFLD prevalence, 23%), whereas liver fat score performed best in the high-risk sample (NAFLD prevalence, 73%).