Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov 26;14(11):e0224942.
doi: 10.1371/journal.pone.0224942. eCollection 2019.

The ZJU index is a powerful surrogate marker for NAFLD in severely obese North American women

Chia-Po Fu  1   2   3 , Hira Ali  4 , Vikrant P Rachakonda  5 , Elizabeth A Oczypok  4 , James P DeLany  6 , Erin E Kershaw  4
Affiliations

The ZJU index is a powerful surrogate marker for NAFLD in severely obese North American women

Chia-Po Fu et al. PLoS One. .

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the western world and is highly associated with multiple cardiometabolic complications. The Zhejiang University (ZJU) index was first developed to predict NAFLD in Chinese populations, where it was shown to have better predictive value than other currently used indices. The aims of the present study were to 1) determine the diagnostic accuracy of ZJU index in identifying NAFLD in a well-phenotyped cohort of obese middle-aged American women and 2) compare its performance with other non-invasive indices for NAFLD identification.

Methods: To achieve this goal, we performed a retrospective analysis of a prospectively-collected cohort of participants enrolled in a weight loss trial for severe obesity (RENEW, clinicaltrials.gov identifier: NCT00712127). One hundred and seven women between the age of 30 and 55 with obesity class II (BMI 35-39.9 kg/m2) or class III (BMI ≥ 40 kg/m2) were recruited for analyses. Hepatic steatosis was measured using liver/spleen attenuation ratio (L/S ratio) from unenhanced abdominal computed tomography. Beside ZJU index, hepatic steatosis index (HSI), lipid accumulation production index (LAPI), and visceral adiposity index (VAI) were also determined and to compare their performance in predicting NAFLD.

Results: Of 107 obese women in the study, 40 (37.4%) met imaging criteria for NAFLD using cut-off value of L/S ratio < 1.1. The ZJU index was positively correlated with HIS, LAPI, but not VAI. The area under the curve was highest for the ZJU index (AUC = 0.742, 95% CI:0.647-0.837), followed by HSI (AUC = 0.728, 95% CI:0.631-0.825), LAPI (AUC = 0.682, CI:0.583-0.781), and VAI (AUC = 0.621, 95% CI:0.518-0.725), respectively, using the Youden method.

Conclusion: The ZJU index is a powerful surrogate marker for NAFLD in severely obese western females and its predictive value was better than that of other commonly used indices for predicting NAFLD. Our study is the first to suggest that the ZJU index could be a promising model for use in western as well as Chinese populations.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Receiver operative characteristic curve of ZJU index, HSI, LAPI and VAI for identifying NAFLD.
VAI: visceral adiposity index; HSI: hepatic steatosis index; LAPI: lipid accumulation index.
See this image and copyright information in PMC

References

    1. McCullough AJ. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis. 2004;8(3):521–33, viii. 10.1016/j.cld.2004.04.004 - DOI - PubMed
    1. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA. 2015;313(22):2263–73. 10.1001/jama.2015.5370 - DOI - PubMed
    1. Sattar N, Forrest E, Preiss D. Non-alcoholic fatty liver disease. BMJ. 2014;349:g4596 10.1136/bmj.g4596 - DOI - PMC - PubMed
    1. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274–85. 10.1111/j.1365-2036.2011.04724.x - DOI - PubMed
    1. Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. J Hepatol. 2016;65(3):589–600. 10.1016/j.jhep.2016.05.013 - DOI - PubMed

Publication types

Associated data