Zou Haoxuan, Pan Wen, Sun Xiaobin
Department of Gastroenterology and Hepatology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China.
Department of Health Management Center, The Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China.
Front Nutr. 2025 May 22;12:1571487. doi: 10.3389/fnut.2025.1571487. eCollection 2025.
Numerous non-invasive tests (NITs) have been developed for non-alcoholic fatty liver disease (NAFLD) over the past few decades. However, their applicability to metabolic-associated steatotic liver disease (MASLD), as redefined and renamed by the recent Delphi Consensus Statement, necessitates further investigation. Consequently, this study aims to systematically evaluate the diagnostic efficacy of five clinically utilized NITs (FLI/FSI/ZJU/LAP/HSI) in assessing the risk of MASLD.
The participants for this study were sourced from the Health Management Center at the Hospital of Chengdu Office of the Tibetan Autonomous Region, as well as from the National Health and Nutrition Examination Survey (NHANES) 2017-2020.3 cycle. The diagnostic efficacy of NITs was thoroughly evaluated and compared via methods such as the area under the curve (AUC), subgroup AUC, and clinical utility.
This study incorporated a total of 2,187 participants from the Health Management Center cohort and 5,524 participants from the NHANES cohort. In both cohorts, the FLI, FSI, LAP, ZJU, and HSI performed well in identifying those at high risk for MASLD. This effectiveness was consistently observed across various subgroups, including those defined by age, sex, race, overweight, hypertension, and diabetes status. Specifically, within the NHANES cohort, the FSI and FLI emerged as superior predictors of MASLD risk, with AUC values of 0.836 (95% CI: 0.826-0.847) and 0.835 (95% CI: 0.825-0.845), respectively. The difference in the AUC between these two NITs was not statistically significant ( > 0.05). In contrast, the ZJU, FLI, and FSI were more predictive of MASLD risk in the Health Management Center cohort. The AUC and 95% CI were: 0.815 (0.797-0.832), 0.810 (0.792-0.828), and 0.805 (0.787-0.823), respectively, and the difference in the AUC among them was not statistically significant ( > 0.05). The results remained the same when analyzed from the point of view of clinical utility, i.e., NRI, IDI, and DCA analyses were performed.
Overall, the FLI, FSI, ZJU, LAP, and HSI continue to demonstrate significant diagnostic value, even when they are applied to the newly designated MASLD and are suitable for screening in high-risk populations.
在过去几十年中，已经开发出许多用于非酒精性脂肪性肝病（NAFLD）的非侵入性检测方法（NITs）。然而，根据最近的德尔菲共识声明重新定义和命名的代谢相关脂肪性肝病（MASLD），这些检测方法对其的适用性需要进一步研究。因此，本研究旨在系统评估五种临床应用的NITs（FLI/FSI/ZJU/LAP/HSI）在评估MASLD风险方面的诊断效能。
本研究的参与者来自西藏自治区成都办事处医院健康管理中心，以及2017 - 2020.3周期的美国国家健康与营养检查调查（NHANES）。通过曲线下面积（AUC）、亚组AUC和临床效用等方法，对NITs的诊断效能进行了全面评估和比较。
本研究共纳入了来自健康管理中心队列的2187名参与者和来自NHANES队列的5524名参与者。在两个队列中，FLI、FSI、LAP、ZJU和HSI在识别MASLD高风险人群方面表现良好。在包括年龄、性别、种族、超重、高血压和糖尿病状态定义的各个亚组中，均一致观察到这种有效性。具体而言，在NHANES队列中，FSI和FLI是MASLD风险的更好预测指标，AUC值分别为0.836（95%CI：0.826 - 0.847）和0.835（95%CI：0.825 - 0.845）。这两种NITs之间的AUC差异无统计学意义（>0.05）。相比之下，在健康管理中心队列中，ZJU、FLI和FSI对MASLD风险的预测性更强。AUC及95%CI分别为：0.815（0.797 - 0.832）、0.810（0.792 - 0.828）和0.805（0.787 - 0.823），它们之间的AUC差异无统计学意义（>0.05）。从临床效用角度分析，即进行NRI、IDI和DCA分析时，结果保持不变。
总体而言，即使将FLI、FSI、ZJU、LAP和HSI应用于新定义的MASLD，它们仍继续显示出显著的诊断价值，适用于高危人群的筛查。
