Non–Laboratory-Based Self-Assessment Screening Score for Non-Alcoholic Fatty Liver Disease: Development, Validation and Comparison with Other Scores

Abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a prevalent and rapidly increasing disease worldwide; however, no widely accepted screening models to assess the risk of NAFLD are available. Therefore, we aimed to develop and validate a self-assessment score for NAFLD in the general population using two independent cohorts.MethodsThe development cohort comprised 15676 subjects (8313 males and 7363 females) who visited the National Health Insurance Service Ilsan Hospital in Korea in 2008–2010. Anthropometric, clinical, and laboratory data were examined during regular health check-ups and fatty liver diagnosed by abdominal ultrasound. Logistic regression analysis was conducted to determine predictors of prevalent NAFLD and to derive risk scores/models. We validated our models and compared them with other existing methods using an external cohort (N = 66868).ResultsThe simple self-assessment score consists of age, sex, waist circumference, body mass index, history of diabetes and dyslipidemia, alcohol intake, physical activity and menopause status, which are independently associated with NAFLD, and has a value of 0–15. A cut-off point of ≥8 defined 58% of males and 36% of females as being at high-risk of NAFLD, and yielded a sensitivity of 80% in men (77% in women), a specificity of 67% (81%), a positive predictive value of 72% (63%), a negative predictive value of 76% (89%) and an AUC of 0.82 (0.88). Comparable results were obtained using the validation dataset. The comprehensive NAFLD score, which includes additional laboratory parameters, has enhanced discrimination ability, with an AUC of 0.86 for males and 0.91 for females. Both simple and comprehensive NAFLD scores were significantly increased in subjects with higher fatty liver grades or severity of liver conditions (e.g., simple steatosis, steatohepatitis).ConclusionsThe new non–laboratory-based self-assessment score may be useful for identifying individuals at high-risk of NAFLD. Further studies are warranted to evaluate the utility and feasibility of the scores in various settings.

Relationship Between Relative Skeletal Muscle Mass and Nonalcoholic Fatty Liver Disease: A 7‐Year Longitudinal Study

“…First, we defined incident NAFLD or resolution of existing baseline NAFLD using the HSI scoring system, not by liver biopsy, which is the gold standard tool of diagnosis for NAFLD . However, several recent studies have revealed external validations of HSI scores by comparing liver biopsy results and other radiologic data obtained by abdominal ultrasonography, CAP, or liver MRS in multi‐ethnic samples, including large, population‐based Asian samples . Moreover, change in HSI score was reported to reflect change in fat content in the liver .…”

Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI‐based predictive scores

“… score in the EuMaRCS study population, to evaluate generalizability and true replication in a similar but independent population that closely reflects the characteristics of their target population (i.e. LARC patients) . Patients’ selection criteria, sample size and the proportion of patients with high surgical difficulty were similar between the Escal et al .…”

Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B

“…The degree of liver fibrosis was assessed using previous validated liver fibrosis prediction models: (1) the NAFLD fibrosis score, (2) the fibrosis‐4 index, and (3) Forns index . Liver steatosis was defined using previous validated fatty liver prediction models: (1) the fatty liver index and (2) the comprehensive NAFLD score . The equations are described in Table S1.…”

“…The equations are described in Table S1. Serum albumin was not measured in the KNHANES; therefore, significant fibrosis was defined as either the highest quartile of the NAFLD fibrosis score, the highest quintile of Forns index, or fibrosis‐4 index ≥2.67, whereas a fatty liver index ≥30 or a comprehensive NAFLD score ≥40 was considered indicative of a fatty liver …”