Influence of Ethnicity on the Accuracy of Non-Invasive Scores Predicting Non-Alcoholic Fatty Liver Disease

Abstract

ObjectivesPresence of non-alcoholic fatty liver disease (NAFLD) can predict risks for diabetes, cardiovascular disease and advanced liver disease in the general population. We aimed to establish a non-invasive score for prediction of NAFLD in Han Chinese, the largest ethnic group in the world, and detect whether ethnicity influences the accuracy of such a score.MethodsLiver fat content (LFAT) was measured by quantitative ultrasound in 3548 subjects in the Shanghai Changfeng Community and a Chinese score was created using multivariate logistic regression analyses. This new score was internally validated in Chinese and externally in Finns. Its diagnostic performance was compared to the NAFLD liver fat score, fatty liver index (FLI) and hepatic steatosis index (HSI) developed in Finns, Italians and Koreans. We also analyzed how obesity related to LFAT measured by 1H-MRS in 79 Finns and 118 Chinese with type 2 diabetes (T2D).ResultsThe metabolic syndrome and T2D, fasting serum insulin, body mass index (BMI) and AST/ALT ratio were independent predictors of NAFLD in Chinese. The AUROC in the Chinese validation cohort was 0.76 (0.73–0.78) and in Finns 0.73 (0.68–0.78) (p<0.0001). 43%, 27%, 32% and 42% of Chinese had NAFLD when determined by the Chinese score, NAFLD liver fat score (p<0.001 vs. Chinese score), FLI (p<0.001) and HSI (NS). For any given BMI and waist circumference, the Chinese had a markedly higher LFAT than the Finns.ConclusionThe predictors of NAFLD in Han Chinese are as in Europids but the Chinese have more LFAT for any given degree of obesity than Europids. Ethnicity needs to be considered when NAFLD is predicted using risk scores.

Fatty liver index and hepatic steatosis index for prediction of non‐alcoholic fatty liver disease in type 1 diabetes

“…However, the performance of HSI in our pilot study was weaker as compared with AUROC 0.812 [0.801; 0.824] described by Lee et al . There are many factors that might contribute to different diagnostic efficacy of the indices, among them—ethnicity, morbidities, and method for diagnosis of liver steatosis being the main . All 40 patients in our study were white Europeans with type 1 diabetes and without previously diagnosed liver diseases.…”

Associations Between Body Fat, Muscle Mass, and Nonalcoholic Fatty Liver Disease: A Population‐Based Study

“…This potentially could have led to diagnostic misclassification. Validation studies of the FLI in other Chinese populations have reported areas under the receiver operating curve (AUROC) ranging from 0.76 to 0.88, but given that we used a higher FLI cut‐off value than that recommended for the Chinese population, we expect to have smaller misclassification bias. Furthermore, because our study population is relatively ethnically homogeneous (Han Chinese), we anticipate a higher AUROC of the FLI in this analysis.…”

Noninvasive Assessment of Liver Disease in Patients With Nonalcoholic Fatty Liver Disease

“…[137][138][139] Thus, caution is requested when extrapolating results of noninvasive tests from nondiabetic populations to patients with diabetes. Also the role of ethnicity may be important to take into account, 140,141 as most available studies have been done in Caucasians. Further studies are needed to address these issues.…”