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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Digestive and Liver DiseaseAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Nonalcoholic fatty liver disease.N Engl J Med. 2002; 346: 1221-1231
- Diagnosis and therapy of nonalcoholic steatohepatitis.Gastroenterology. 2008; 134: 1682-1698
- Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults.J Gastroenterol Hepatol. 2006; 21: 138-143
- Metabolic significance of nonalcoholic fatty liver disease in nonobese, nondiabetic adults.Arch Intern Med. 2004; 164: 2169-2175
- The association of nonalcoholic fatty liver disease with metabolic syndrome.J Korean Acad Fam Med. 2007; 28: 667-674
- The natural history of nonalcoholic fatty liver disease: a population-based cohort study.Gastroenterology. 2005; 129: 113-121
- Association between nonalcoholic fatty liver disease and coronary artery disease.Coron Artery Dis. 2007; 18: 433-436
- Prediction of coronary heart disease using risk factor categories.Circulation. 1998; 97: 1837-1847
- The utility of radiological imaging in nonalcoholic fatty liver disease.Gastroenterology. 2002; 123: 745-750
- Internal validation of predictive models: efficiency of some procedures for logistic regression analysis.J Clin Epidemiol. 2001; 54: 774-781
- The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation.Am J Gastroenterol. 2007; 102: 2708-2715
- Computed tomography in nonalcoholic fatty liver disease: a useful tool for hepatosteatosis assessment?.Dig Dis Sci. 2006; 51: 346-351
- Unenhanced CT for assessment of macrovesicular hepatic steatosis in living liver donors: comparison of visual grading with liver attenuation index.Radiology. 2007; 244: 479-485
- Introduction of fast MR imaging in the assessment of hepatic steatosis.Magn Reson Imaging. 1997; 15: 287-293
- The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population.BMC Gastroenterol. 2006; 6: 33-39
- Clinical and histologic spectrum of nonalcoholic fatty liver disease associated with normal ALT values.Hepatology (Baltimore, MD). 2003; 37: 1286-1292
- Quantitative estimation of attenuation in ultrasound video images: correlation with histology in diffuse liver disease.Invest Radiol. 2000; 35: 319-324
- Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease.Clin Radiol. 1991; 43: 26-31
- Increased liver echogenicity at ultrasound examination reflects degree of steatosis but not of fibrosis in asymptomatic patients with mild/moderate abnormalities of liver transaminases.Dig Liver Dis. 2002; 34: 516-522
- Body-mass index and mortality in Korean men and women.N Engl J Med. 2006; 355: 779-787
- The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.Epidemiol Rev. 2007; 29: 6-28
- The characteristics of Korean diabetes.Korean J Diabet Assoc. 1992; 16: 163-173
- Changing patterns of the prevalence of diabetes mellitus in Korea.Korean J Diabet Assoc. 1981; 6: 71
- Propensity for non-alcoholic fatty liver disease: more evidence for ethnic susceptibility.Liver Int. 2009; 29: 4-5
Article Info
Publication History
Published online: September 22, 2009
Accepted:
August 11,
2009
Received:
March 16,
2009
Identification
Copyright
© 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Inc. All rights reserved.
