Non-laboratory-based self-assessment screening score for non-alcoholic fatty liver disease: development, validation and comparison with other scores.

Abstract

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a prevalent and rapidly

increasing disease worldwide; however, no widely accepted screening models to

assess the risk of NAFLD are available. Therefore, we aimed to develop and

validate a self-assessment score for NAFLD in the general population using two

independent cohorts. METHODS: The development cohort comprised 15676 subjects

(8313 males and 7363 females) who visited the National Health Insurance Service

Ilsan Hospital in Korea in 2008-2010. Anthropometric, clinical, and laboratory

data were examined during regular health check-ups and fatty liver diagnosed by

abdominal ultrasound. Logistic regression analysis was conducted to determine

predictors of prevalent NAFLD and to derive risk scores/models. We validated our

models and compared them with other existing methods using an external cohort (N

= 66868). RESULTS: The simple self-assessment score consists of age, sex, waist

circumference, body mass index, history of diabetes and dyslipidemia, alcohol

intake, physical activity and menopause status, which are independently

associated with NAFLD, and has a value of 0-15. A cut-off point of >/= 8 defined

58% of males and 36% of females as being at high-risk of NAFLD, and yielded a

sensitivity of 80% in men (77% in women), a specificity of 67% (81%), a positive

predictive value of 72% (63%), a negative predictive value of 76% (89%) and an

AUC of 0.82 (0.88). Comparable results were obtained using the validation

dataset. The comprehensive NAFLD score, which includes additional laboratory

parameters, has enhanced discrimination ability, with an AUC of 0.86 for males

and 0.91 for females. Both simple and comprehensive NAFLD scores were

significantly increased in subjects with higher fatty liver grades or severity of

liver conditions (e.g., simple steatosis, steatohepatitis). CONCLUSIONS: The new

non-laboratory-based self-assessment score may be useful for identifying

individuals at high-risk of NAFLD. Further studies are warranted to evaluate the

utility and feasibility of the scores in various settings.