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Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease

  • Jeong-Hoon Lee
    Affiliations
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea
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  • Donghee Kim
    Correspondence
    Corresponding author. Tel.: +82 2 2112 5574; fax: +82 2 2112 5635.
    Affiliations
    Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, 39th FL Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul 135-984, Republic of Korea
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  • Hwa Jung Kim
    Affiliations
    Department of Preventive Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea

    Cancer Center, Asan Medical Center, 388-1 Pungnap-2-dong, Songpa-gu, Seoul 138-736, Republic of Korea
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  • Chang-Hoon Lee
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul Municipal Boramae Hospital, 39 Boramae Road, Dongjak-gu, Seoul 156-707, Republic of Korea
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  • Jong In Yang
    Affiliations
    Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, 39th FL Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul 135-984, Republic of Korea
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  • Won Kim
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul Municipal Boramae Hospital, 39 Boramae Road, Dongjak-gu, Seoul 156-707, Republic of Korea
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  • Yoon Jun Kim
    Affiliations
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea
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  • Jung-Hwan Yoon
    Affiliations
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea
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  • Sang-Heon Cho
    Affiliations
    Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, 39th FL Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul 135-984, Republic of Korea
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  • Myung-Whun Sung
    Affiliations
    Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital, Healthcare System Gangnam Center, 39th FL Gangnam Finance Center, 737 Yeoksam-dong, Gangnam-gu, Seoul 135-984, Republic of Korea
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  • Hyo-Suk Lee
    Affiliations
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea
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Published:September 22, 2009DOI:https://doi.org/10.1016/j.dld.2009.08.002

      Abstract

      Background/Aims

      To optimize management of nonalcoholic fatty liver disease (NAFLD), a simple screening tool is necessary. In this study, we aimed to devise a simple index of NAFLD.

      Study

      A cross-sectional study with 10,724 health check-up subjects (5362 cases with NAFLD versus age- and sex-matched controls) was conducted. Study subjects were randomly assigned to a derivation cohort or a validation cohort.

      Results

      Multivariate analysis indicated that high serum alanine aminotransferase (ALT) to serum aspartate aminotransferase (AST) ratio, high body mass index (BMI), and diabetes mellitus were independent risk factors of NAFLD (all P < 0.001). Using these variables, a formula was derived by a logistic regression model: hepatic steatosis index (HSI) = 8 × (ALT/AST ratio) + BMI (+2, if female; +2, if diabetes mellitus). HSI had an area under receiver-operating curve of 0.812 (95% confidence interval, 0.801–0.824). At values of <30.0 or >36.0, HSI ruled out NAFLD with a sensitivity of 93.1%, or detected NAFLD with a specificity of 92.4%, respectively. Of 2692 subjects with HSI <30.0 or >36.0 in the derivation cohort, 2305 (85.6%) were correctly classified. HSI was validated in the subsequent validation cohort.

      Conclusion

      HSI is a simple, efficient screening tool for NAFLD that may be utilized for selecting individuals for liver ultrasonography and for determining the need for lifestyle modifications.

      Keywords

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