Prediction of Nonalcoholic Fatty Liver Disease Using Noninvasive and Non-Imaging Procedures in Japanese Health Checkup Examinees

Access to imaging is limited for diagnosing nonalcoholic fatty liver disease (NAFLD) in general populations. This study evaluated the diagnostic performance of noninvasive and nonimaging indexes to predict NAFLD in the general Japanese population. Health checkup examinees without hepatitis virus infection or habitual alcohol drinking were included. Fatty liver was diagnosed by ultrasonography. The hepatic steatosis index (HSI), Zhejiang University (ZJU) index, and fatty liver index (FLI) were determined, and risk of advanced liver fibrosis was evaluated by the fibrosis-4 index. NAFLD was diagnosed in 1935 (28.0%) of the 6927 subjects. The area under the receiver operating characteristic (AUROC) curve of the HSI, ZJU index, and FLI was 0.874, 0.886, and 0.884, respectively. The AUROC of the ZJU index (p < 0.001) and FLI (p = 0.002) was significantly greater than that for the HSI. In subjects with a high risk of advanced fibrosis, the sensitivity of the HSI, ZJU index, and FLI were 88.8%, 94.4%, and 83.3% with a low cut-off value and the specificity was 98.5%, 100%, and 100% with a high cut-off value. In conclusion, all indexes were useful to diagnose NAFLD in the general Japanese population and in subjects with potentially advanced liver fibrosis.

Comparative Assessment and External Validation of Hepatic Steatosis Formulae in a Community-Based Setting

Several hepatic steatosis formulae have been validated in various cohorts using ultrasonography. However, none of these studies has been validated in a community-based setting using the gold standard method. Thus, the aim of this study was to externally validate hepatic steatosis formulae in community-based settings using magnetic resonance imaging (MRI). A total of 1301 community-based health checkup subjects who underwent liver fat quantification with MRI were enrolled in this study. Diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUROC). Non-alcoholic fatty liver disease (NAFLD) liver fat score showed the highest diagnostic performance with an AUROC of 0.72, followed by Framingham steatosis index (0.70), hepatic steatosis index (HSI, 0.69), ZJU index (0.69), and fatty liver index (FLI, 0.68). There were considerable gray zones in three fatty liver prediction models using two cutoffs (FLI, 28.9%; HSI, 48.9%; and ZJU index, 53.6%). The diagnostic performance of NAFLD liver fat score for detecting steatosis was comparable to that of ultrasonography. The diagnostic agreement was 72.7% between NAFLD liver fat score and 70.9% between ultrasound and MRI. In conclusion, the NAFLD liver fat score showed the best diagnostic performance for detecting hepatic steatosis. Its diagnostic performance was comparable to that of ultrasonography in a community-based setting.

P0803SYNERGISTIC INTERACTION OF ACUTE HYPERGLYCEMIC STRESS AND NON-ALCOHOLIC FATTY LIVER DISEASE ON THE DEVELOPMENT OF ALBUMINURIA IN GENERAL POPULATION

Background and Aims Both increased glycemic exposure and non-alcoholic fatty liver disease (NFALD) are independent risks of vascular endothelial dysfunction. To find interactive effects of acute hyperglycemia and hepatic necro-inflammation on initiation of albuminuria, we conducted this nation-wide, population-based interaction analysis using acute-to-chronic glycemic ratio (ACGR) as a candidate indicator of acute increased glycemic exposure and ZJU index as an indicator of NFALD. Method Eligible as cases were all native Koreans aged 20 years or older without significant medical illness. A total of 9494 participants were divided into quintiles according to their ACGR results and stratified by sex. Results: Participants in the highest ACGR quintile were more obese and they were more likely to have elevated BP and increased glycemic exposure as compared with other quintiles. Restricted cubic regression analyses revealed that there was non-linear relationship of ACGR and ZJU index with albuminuria. Multiple logistic regression, adjusted for various conventional risk factor of kidney disease, demonstrated that both ACGR (adjusted OR = 5.388, 95% CI = 1.119-25.95) and ZJU index (adjusted OR = 1.057, 95% CI = 1.002-1.114) were independent predictor of albuminuria. Interestingly, our interaction analysis revealed that ACGR had bigger effect on the risk of albuminuria in participant with elevated ZJU index than those without (adjusted RERI = 2.296, 95% CI = 2.277-2.313; adjusted AP = 0.643, 95% CI = 0.472-0.814; adjusted SI = 8.135, 95% CI = 7.267-9.003). Conclusion Our findings suggest that the interaction of acute hyperglycemia and abnormal hepatic fat metabolism may exert synergistic biologic effect on the development of albuminuria.