Reducing NAFLD‐screening time: A comparative study of eight diagnostic methods offering an alternative to ultrasound scans

Abstract

Background & Aims The use of ultrasound scan (US) in non‐alcoholic fatty liver disease (NAFLD) screening overloads US waiting lists. We hypothesized and tested a hybrid two‐step method, consisting of applying a formula, to exclude subjects at low risk, before US. Methods The sample included 2970 males and females (937 with NAFLD) diagnosed by US. We selected eight formulas: Fatty Liver Index (FLI), Hepatic Steatosis Index (HIS), body mass index (BMI), waist circumference (WC), Abdominal Volume Index (AVI), waist‐to‐height ratio (WHtR), waist/height0.5 (WHT.5R) and Body Roundness Index (BRI), and calculated their performance in the two‐step method evaluating percentage reduction of the number of liver US (US reduction percentage), percentage of false negative and percentage of NAFLD identified. Results The US reductions percentage were 52.2% (WHtR), 52.1% (HIS), 51.8% (FLI), 50.8% (BRI), 50.7% (BMI and WHt_5R), 46.5% (WC) and 45.2% (AVI). The false negative percentage were 8.5% (WHtR), 7.9% (BRI), 7.3% (WHt_5R), 7.2% (BMI), 6.7% (HIS), 6.6% (FLI), 5.6% (WC) and 5.2% (AVI). The best percentage of NALFD identified was obtained using AVI (83.6%) before US, then WC (82.2%), FLI (79%), HIS (78.9%), BMI (77.3%), WHt_5R (76.9%), BRI (74.8%) and WHtR (73%). Conclusion The best formula to use in two‐step diagnostic NAFLD screening was AVI, which showed a low false negative rate and a higher percentage of identified NAFLD. Other studies evaluating the economic advantages of this screening method are warranted.

Which Metabolic Index is Appropriate for Predicting Non-alcoholic Steatohepatitis?

“…20 This result is in contrast to the previous reports that showed a strong association between the mentioned index and NASH. 21,22 BSI was the next metabolic index that was not related to NASH in our study. This result is opposite to the previous reports that showed an association between the mentioned index and NASH.…”

Non-Alcoholic Fatty Liver Disease Is Associated with Higher Metabolic Expenditure in Overweight and Obese Subjects: A Case-Control Study

“…Examination of the visible liver parenchyma was performed with a 3.5 MHz transducer. A scoring system was adopted to obtain a semi-quantitative evaluation of fat in the liver [15,16,17,18].…”

Selecting the best machine learning algorithm to support the diagnosis of Non-Alcoholic Fatty Liver Disease: A meta learner study

“…Details about the study population have been published elsewhere [9]. Briefly, a prospective cohort study was conducted by the Laboratory of Epidemiology and Biostatistics of the National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital (Castellana Grotte, Bari, Italy).…”

“…However, for large scale screening studies, serum bio markers and steatosis scores indexes have been preferred, as the availability and cost of US has a substantial impact on screening feasibility. 7 One of the best validated INDEXES is the Fatty Liver Index (FLI) [8], although other scores or anthropometric measures work as well as the FLI in predicting the NAFLD risk [9].…”

“…In a previous study, we compared the performance of eight alternative hybrid methods to identify subjects with NAFLD in a large population [9]. In that setting, predictive formulas were used as a first approach strategy, to identify subjects considered to be at greater risk of steatosis, needing to be scheduled for later US.…”