Commentary
Several scores based on easily measurable biochemical and clinical parameters, including the fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), and NAFLD liver fat score (LFS), have been developed for the detection of NAFLD. However, comparative information regarding the efficacy of these scores for predicting NAFLD in normal and high-risk individuals is lacking.
In order to evaluate these four NAFLD detection scores, L. Lind et al. (Uppsala University, Sweden) performed NAFLD screening in a population-based sample of 50-year-old individuals in Uppsala, Sweden (Prospective investigation of obesity, energy and metabolism – POEM study) and a high-risk population (EFFECT studies). NAFLD was defined as liver fat > 5.5% using magnetic resonance imaging-proton density fat fraction.
In the population-based setting (POEM), FLI showed the highest ROC AUC and was significantly better than the LAP score for detection of NAFLD. The other three indices performed equally.
In the high-risk setting (EFFECT), LFS performed best. The ROC AUC for LFS was significantly higher than that for fatty liver index and LAP, but not HSI.
In conclusion, FLI seems preferable in the population-based setting, while LFS performed best in the high-risk setting in this study.
