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 of 20% to 35% in the general population. Several non-invasive indices based on routinely available biochemical and physical parameters have been developed for the detection of NAFLD. However, data comparing the efficacy of these indices within a population-based sample are lacking.
To better understand the applicability of different non-invasive indices for detecting NAFLD in a population-based sample [based on prospective investigation of obesity, energy and metabolism (POEM) study] vs a high-risk sample (based on EFFECT studies).
To compare the efficacy of four non-invasive indices, fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), and NAFLD liver fat score (LFS), in predicting NAFLD in population-based samples comprising normal and high-risk individuals.
NAFLD screening was performed in a population-based sample of 50-year-old individuals in Uppsala, Sweden (n = 310; POEM study) and a high-risk population comprising patients with a body mass index > 25 kg/m2 and either high plasma triglycerides (≥ 1.7 mM) 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 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.
In the populationbased vs high-risk setting, the indices performed differently. FLI was preferable in the population-based setting, while LFS performed best in the high-risk setting.