Non-alcoholic fatty liver disease in diabetes: When to refer to the hepatologist?

Table 1 Few available non-invasive models for evaluating steatosis and fibrosis in patients of diabetes with non-alcoholic fatty liver disease

Index	Components	Cut-offs	Sensitivity, %	Specificity, %
Steatosis
FLI[77]	WC, BMI, TG and GGT	< 30	87.0	64.0
		≥ 60	61.0	86.0
HSI[94]	AST, ALT, BMI, diabetes, female sex	< 30	93.1	39.6
		> 36	45.1	92.4
Fibrosis (stage 2, 3 or 4)
APRI[95]	AST and platelet count	0.518	50.00	89.19
FIB-4[95]	Age, AST, ALT and platelet count	1.743	63.33	94.59
NFS[95]	Age, BMI, IFG and diabetes, AST-to-ALT ratio, platelet count and albumin	-0.054	50.00	86.21

Formulae: FLI = (e^{0.953*loge (TG) + 0.139*BMI + 0.718*loge (GGT) + 0.053*WC- 15.745})/(1 + e^{0.953*loge (TG) + 0.139*BMI + 0.718*loge (GGT) + 0.053*WC - 15.745})*100[77]; HSI = 8 × (ALT/AST ratio) + BMI (+ 2, if female; + 2, if diabetes mellitus)[94]; APRI = {[AST(U/L)/upper limit of normal AST (U/L)] × 100/platelet count (10⁹/L)}[95]; FIB-4 = Age (years) × AST (U/L)/[platelet count (10⁹/L) × ALT^1/2 (U/L)][95]; NFS = − 1.675 + 0.037 × age (years) + 0.094 × BMI (kg/m²) + 1.13 × IFG/diabetes (yes = 1, no = 0) + 0.99 × AST/ALT ratio– 0.013 × platelet count (10⁹/L) – 0.66 × albumin (g/dL)[95]. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; APRI: Aspartate aminotransferase-to-platelet ratio; BMI: Body mass index; FIB-4: Fibrosis-4 score; FLI: Fatty liver index; GGT: Gamma-glutamyltransferase; HG: Haptoglobins; HSI: Hepatic steatosis index; IFG: Impaired fasting glucose; NFS: Non-alcoholic fatty liver disease fibrosis score; TG: Triglyceride; WC: Waist circumference.