Clayton-Chubb Daniel, Commins Isabella, Roberts Stuart K, Majeed Ammar, Woods Robyn L, Ryan Joanne, Schneider Hans G, Lubel John S, Hodge Alexander D, McNeil John J, Kemp William W
Department of Gastroenterology, Alfred Health, Melbourne, VIC Australia.
School of Translational Medicine, Monash University, Melbourne, VIC Australia.
NPJ Gut Liver. 2025;2(1):9. doi: 10.1038/s44355-025-00021-3. Epub 2025 Apr 19.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant cause of chronic liver disease globally, and the rising prevalence of MASLD is occurring in parallel with the global aging population. The use of non-invasive biomarker tools to rule-in or rule-out hepatic steatosis is important in large epidemiological studies in this field. While the Fatty Liver Index (FLI) is the best validated tool in older adults, not all studies will have the necessary parameters for steatosis identification. This retrospective post-hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) study involved 16,703 Australian adults aged ≥70 years. Using the FLI as the 'gold standard' index, we evaluated the correlation with other indices: the Dallas Steatosis Index (DSI), Framingham Steatosis Index, ZJU index (ZJU), Hepatic Steatosis Index (HSI), Lipid Accumulation Product (LAP), and Visceral Adiposity Index (VAI), as well as age- and sex-adjusted outcome measures including mortality, major adverse cardiovascular events (MACE), atrial fibrillation (AF), and persistent physical disability. Of the non-FLI indices, the DSI and FSI had the highest percentage of participants correctly classified as having MASLD (97.7% and 93.8% respectively). The FSI, LAP, and VAI were associated with MACE. The FSI and FLI were predictive of incident AF. The FLI, DSI, FSI, LAP and VAI were associated with physical disability. No MASLD score was associated with increased mortality. Indeed, MASLD defined by the ZJU and HSI were both inversely associated with mortality. As such, we've demonstrated that the FSI and DSI are the most accurate scores for identifying MASLD in older adults when compared to the FLI as the gold standard. The FSI is associated with MACE, AF, and persistent physical disability, lending support to its use in identifying older persons with MASLD when the FLI is unable to be calculated.
代谢功能障碍相关脂肪性肝病（MASLD）是全球慢性肝病的一个重要病因，且MASLD患病率的上升与全球人口老龄化同步出现。在该领域的大型流行病学研究中，使用非侵入性生物标志物工具来判定或排除肝脂肪变性很重要。虽然脂肪肝指数（FLI）是在老年人中验证度最高的工具，但并非所有研究都具备用于识别脂肪变性的必要参数。这项针对老年人阿司匹林减少事件（ASPREE）研究的回顾性事后分析涉及16703名年龄≥70岁的澳大利亚成年人。以FLI作为“金标准”指数，我们评估了它与其他指数的相关性：达拉斯脂肪变性指数（DSI）、弗雷明汉姆脂肪变性指数、浙江大学指数（ZJU）、肝脂肪变性指数（HSI）、脂质蓄积产物（LAP）和内脏脂肪指数（VAI），以及年龄和性别调整后的结局指标，包括死亡率、主要不良心血管事件（MACE）、心房颤动（AF）和持续性身体残疾。在非FLI指数中，DSI和FSI将参与者正确分类为患有MASLD的比例最高（分别为97.7%和93.8%）。FSI、LAP和VAI与MACE相关。FSI和FLI可预测新发AF。FLI、DSI、FSI、LAP和VAI与身体残疾相关。没有MASLD评分与死亡率增加相关。事实上，由ZJU和HSI定义的MASLD均与死亡率呈负相关。因此，我们已经证明，与作为金标准的FLI相比，FSI和DSI是识别老年人MASLD最准确的评分。FSI与MACE、AF和持续性身体残疾相关，这支持了在无法计算FLI时将其用于识别患有MASLD的老年人。
