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Cited by 34Liver Disease Diagnosis and TreatmentDiabetes, Cardiovascular Risks, and LipoproteinsBody Composition Measurement Techniques

Comparison of obesity-related indices for identifying nonalcoholic fatty liver disease: a population-based cross-sectional study in China

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Xie, Fangfei, Pei, Yuyu, Zhou, Quan, Cao, Deli, Wang, Yun·2021·Lipids in Health and Disease
DOI 10.1186/s12944-021-01560-3PMC PMC8502306
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Abstract

BACKGROUND: The relationship between nonalcoholic fatty liver disease (NAFLD) and obesity-related indices has been analyzed separately thus far, and evidence comparing these indices together is still lacking, especially in China. This study aimed to comprehensively evaluate the predictive performance of anthropometric and metabolic indices to identify NAFLD in Chinese adults. METHODS: This study recruited a total of 1748 participants who were 18 years or older in southeastern China. The systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TGs), low-density lipoprotein (LDL), waist circumference (WC), a body shape index (ABSI), atherogenic index of plasma (AIP), abdominal volume index (AVI), body adiposity index (BAI), body mass index (BMI), body roundness index (BRI), conicity index (CI), triglyceride glucose (TyG), waist hip ratio (WHR), and waist height ratio (WHtR) were measured. The association between these indices and NAFLD was analyzed via logistic analyses with odds ratios (ORs). Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) were used to compare the predictive performance of these indices to identify NAFLD. RESULTS: BMI had the greatest total AUC (AUC = 0.841) in the ROC curve analysis. However, BRI and BMI both had the best diagnostic ability in males (AUC = 0.812), and BRI had the best diagnostic ability in females (AUC = 0.849). Furthermore, AVI had the greatest AUC for patients who were ~ 20 (AUC = 0.892) and ~ 40 years old (AUC = 0.831), while TyG showed a higher predictive ability than AVI in those who were ~ 60 years old (AUC = 0.766). CONCLUSION: This study identified sex- and age-specific indices for predicting NAFLD in Chinese subjects. Compared with indices for all age groups, sex- and age-specific indices can provide more accurate assistance for clinical diagnosis and treatment.

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References 46 · Cited by 34

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  1. [1]Liu K McCaughan GW Epidemiology and etiologic associations of non-alcoholic fatty liver disease and associated HCC Adv Exp Med Biol 2018 1061 3 18 10.1007/978-981-10-8684-7_2 29956203 · DOI
  2. [2]Leoni S Tovoli F Napoli L Serio I Ferri S Bolondi L Current guidelines for the management of non-alcoholic fatty liver disease: a systematic review with comparative analysis World J Gastroenterol 2018 24 30 3361 3373 10.3748/wjg.v24.i30.3361 30122876 PMC6092580 · DOI
  3. [3]Araujo AR Rosso N Bedogni G Tiribelli C Bellentani S Global epidemiology of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: what we need in the future Liver Int 2018 38 Suppl 1 47 51 10.1111/liv.13643 29427488 · DOI
  4. [4]Andronescu CI Purcarea MR Babes PA Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications J Med Life 2018 11 1 20 23 29696060 PMC5909941
  5. [5]Perumpail BJ Khan MA Yoo ER Cholankeril G Kim D Ahmed A Clinical epidemiology and disease burden of nonalcoholic fatty liver disease World J Gastroenterol 2017 23 47 8263 8276 10.3748/wjg.v23.i47.8263 29307986 PMC5743497 · DOI
  6. [6]Sanyal AJ Past, present and future perspectives in nonalcoholic fatty liver disease Nat Rev Gastroenterol Hepatol 2019 16 6 377 386 10.1038/s41575-019-0144-8 31024089 · DOI · Paper page
  7. [7]Marchisello S, Di Pino A, Scicali R, Urbano F, Piro S, Purrello F, et al. Pathophysiological, molecular and therapeutic issues of nonalcoholic fatty liver disease: an overview. Int J Mol Sci. 2019;20(8). 10.3390/ijms20081948. PMC6514656 31010049 · DOI
  8. [8]Farzanegi P Dana A Ebrahimpoor Z Asadi M Azarbayjani MA Mechanisms of beneficial effects of exercise training on non-alcoholic fatty liver disease (NAFLD): roles of oxidative stress and inflammation Eur J Sport Sci 2019 19 7 994 1003 10.1080/17461391.2019.1571114 30732555 · DOI
  9. [9]Hernandez-Rodas MC Valenzuela R Videla LA Relevant aspects of nutritional and dietary interventions in non-alcoholic fatty liver disease Int J Mol Sci 2015 16 10 25168 25198 10.3390/ijms161025168 26512643 PMC4632797 · DOI
  10. [10]Valenzuela R Videla LA The importance of the long-chain polyunsaturated fatty acid n-6/n-3 ratio in development of non-alcoholic fatty liver associated with obesity Food Funct 2011 2 11 644 648 10.1039/c1fo10133a 22008843 · DOI
  11. [11]Wijarnpreecha K Panjawatanan P Aby E Ahmed A Kim D Nonalcoholic fatty liver disease in the over-60s: impact of sarcopenia and obesity Maturitas 2019 124 48 54 10.1016/j.maturitas.2019.03.016 31097179 · DOI · Paper page
  12. [12]Agbim U Carr RM Pickett-Blakely O Dagogo-Jack S Ethnic disparities in adiposity: focus on non-alcoholic fatty liver disease, visceral, and generalized obesity Curr Obes Rep 2019 8 3 243 254 10.1007/s13679-019-00349-x 31144261 PMC6662200 · DOI
  13. [13]Mantovani A Byrne CD Bonora E Targher G Nonalcoholic fatty liver disease and risk of incident type 2 diabetes: a Meta-analysis Diabetes Care 2018 41 2 372 382 10.2337/dc17-1902 29358469 · DOI
  14. [14]Polyzos SA Kountouras J Mantzoros CS Adipose tissue, obesity and non-alcoholic fatty liver disease Minerva Endocrinol 2017 42 2 92 108 10.23736/S0391-1977.16.02563-3 27711029 · DOI · Paper page
  15. [15]Chao HW, Chao SW, Lin H, Ku HC, Cheng CF. Homeostasis of glucose and lipid in non-alcoholic fatty liver disease. Int J Mol Sci. 2019;20(2). 10.3390/ijms20020298. PMC6359196 30642126 · DOI
  16. [16]Targher G Li Y Wang J Tang Y Han X Liu B Hu H Li X Yang K Yuan J Bidirectional association between nonalcoholic fatty liver disease and type 2 diabetes in Chinese population: evidence from the Dongfeng-Tongji cohort study PLoS One 2017 12 3 e0174291 10.1371/journal.pone.0174291 28350839 PMC5369778 · DOI
  17. [17]Arrese M Barrera F Triantafilo N Arab JP Concurrent nonalcoholic fatty liver disease and type 2 diabetes: diagnostic and therapeutic considerations Expert Rev Gastroenterol Hepatol 2019 13 9 849 866 10.1080/17474124.2019.1649981 31353974 · DOI
  18. [18]Li L Liu DW Yan HY Wang ZY Zhao SH Wang B Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies Obes Rev 2016 17 6 510 519 10.1111/obr.12407 27020692 · DOI
  19. [19]Xie F Zhou H Wang Y Atherogenic index of plasma is a novel and strong predictor associated with fatty liver: a cross-sectional study in the Chinese Han population Lipids Health Dis 2019 18 1 170 10.1186/s12944-019-1112-6 31511022 PMC6739922 · DOI
  20. [20]Wang Q Zheng D Liu J Fang L Li Q Atherogenic index of plasma is a novel predictor of non-alcoholic fatty liver disease in obese participants: a cross-sectional study Lipids Health Dis 2018 17 1 284 10.1186/s12944-018-0932-0 30545385 PMC6293612 · DOI
  21. [21]VanWagner LB Khan SS Ning H Siddique J Lewis CE Carr JJ Vos MB Speliotes E Terrault NA Rinella ME Body mass index trajectories in young adulthood predict non-alcoholic fatty liver disease in middle age: the CARDIA cohort study Liver Int 2018 38 4 706 714 10.1111/liv.13603 28963767 PMC5867197 · DOI
  22. [22]Chen Z Qin H Qiu S Chen G Chen Y Correlation of triglyceride to high-density lipoprotein cholesterol ratio with nonalcoholic fatty liver disease among the non-obese Chinese population with normal blood lipid levels: a retrospective cohort research Lipids Health Dis 2019 18 1 162 10.1186/s12944-019-1104-6 31399032 PMC6689160 · DOI
  23. [23]Rachakonda V Wills R DeLany JP Kershaw EE Behari J Differential impact of weight loss on nonalcoholic fatty liver resolution in a north American cohort with obesity Obesity (Silver Spring) 2017 25 8 1360 1368 10.1002/oby.21890 28605159 · DOI
  24. [24]Ren XY Shi D Ding J Cheng ZY Li HY Li JS Pu HQ Yang AM He CL Zhang JP Ma YB Zhang YW Zheng TZ Bai YN Cheng N Total cholesterol to high-density lipoprotein cholesterol ratio is a significant predictor of nonalcoholic fatty liver: Jinchang cohort study Lipids Health Dis 2019 18 1 47 10.1186/s12944-019-0984-9 30744645 PMC6371543 · DOI
  25. [25]Li Y Zheng R Li J Feng S Wang L Huang Z Association between triglyceride glucose-body mass index and non-alcoholic fatty liver disease in the non-obese Chinese population with normal blood lipid levels: a secondary analysis based on a prospective cohort study Lipids Health Dis 2020 19 1 229 10.1186/s12944-020-01409-1 33109219 PMC7592551 · DOI
  26. [26]Guo W Lu J Qin P Li X Zhu W Wu J Xu N Zhang Q The triglyceride-glucose index is associated with the severity of hepatic steatosis and the presence of liver fibrosis in non-alcoholic fatty liver disease: a cross-sectional study in Chinese adults Lipids Health Dis 2020 19 1 218 10.1186/s12944-020-01393-6 33028338 PMC7541277 · DOI
  27. [27]Wang Y Zeng Y Lin C Chen Z Hypertension and non-alcoholic fatty liver disease proven by transient elastography Hepatol Res 2016 46 13 1304 1310 10.1111/hepr.12688 26932594 · DOI
  28. [28]Pan XF Wang L Pan A Epidemiology and determinants of obesity in China Lancet Diabetes Endocrinol 2021 9 6 373 392 10.1016/S2213-8587(21)00045-0 34022156 · DOI
  29. [29]Guerrero-Romero F, Rodríguez-Morán M. Abdominal volume index. an anthropometry-based index for estimation of obesity is strongly related to impaired glucose tolerance and type 2 diabetes mellitus. Arch Med Res. 2003;34(5):428–32. 14602511
  30. [30]Fan JG An introduction of strategies for the management of nonalcoholic fatty liver disease (NAFLD) recommended by Asia Pacific working party on NAFLD Zhonghua Gan Zang Bing Za Zhi 2007 15 7 552 553 17669255
  31. [31]Hamaguchi M Kojima T Ohbora A Takeda N Kato T Aging is a risk factor of nonalcoholic fatty liver disease in premenopausal women World J Gastroenterol 2012 18 3 237 243 10.3748/wjg.v18.i3.237 22294826 PMC3261540 · DOI
  32. [32]Hörist-Kollmann S Strametz-Juranek J Female dietary patterns and the pathogenesis of NAFLD Gend Genome 2018 2 2 49 55 10.1177/2470289718787091 · DOI
  33. [33]Cai M-J Kong X-N Zhao X-Y Influences of gender and age on the prevalence and complications of nonalcoholic fatty liver disease Acta Academiae Medicinae Sinicae 2017 39 4 499 505 10.3881/j.issn.1000-503X.2017.04.007 28877827 · DOI
  34. [34]Mahli A Hellerbrand C Alcohol and obesity: a dangerous Association for Fatty Liver Disease Dig Dis 2016 34 Suppl 1 32 39 10.1159/000447279 27548267 · DOI
  35. [35]Cholankeril G Wong RJ Hu M Perumpail RB Yoo ER Puri P Younossi ZM Harrison SA Ahmed A Liver transplantation for nonalcoholic steatohepatitis in the US: temporal trends and outcomes Dig Dis Sci 2017 62 10 2915 2922 10.1007/s10620-017-4684-x 28744836 · DOI
  36. [36]Kim D Chung GE Kwak MS Seo HB Kang JH Kim W Kim YJ Yoon JH Lee HS Kim CY Body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease Clin Gastroenterol Hepatol 2016 14 1 132 138 10.1016/j.cgh.2015.07.024 26226099 · DOI
  37. [37]Christakoudi S Tsilidis KK Muller DC Freisling H Weiderpass E Overvad K Soderberg S Haggstrom C Pischon T Dahm CC A body shape index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort Sci Rep 2020 10 1 14541 10.1038/s41598-020-71302-5 32883969 PMC7471961 · DOI
  38. [38]Quaye L Owiredu W Amidu N Dapare PPM Adams Y Comparative abilities of body mass index, waist circumference, abdominal volume index, body adiposity index, and Conicity index as predictive screening tools for metabolic syndrome among apparently healthy Ghanaian adults J Obes 2019 2019 8143179 8143110 10.1155/2019/8143179 31565431 PMC6745169 · DOI
  39. [39]Yeşil E Köse B Özdemir M Is body adiposity index a better and easily applicable measure for determination of body fat? J Am Coll Nutr 2020 39 8 700 705 10.1080/07315724.2020.1727378 32155104 · DOI
  40. [40]Thomas DM Bredlau C Bosy-Westphal A Mueller M Shen W Gallagher D Maeda Y McDougall A Peterson CM Ravussin E Heymsfield SB Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model Obesity (Silver Spring) 2013 21 11 2264 2271 10.1002/oby.20408 23519954 PMC3692604 · DOI · Paper page
  41. [41]Umano GR Shabanova V Pierpont B Mata M Nouws J Trico D Galderisi A Santoro N Caprio S A low visceral fat proportion, independent of total body fat mass, protects obese adolescent girls against fatty liver and glucose dysregulation: a longitudinal study Int J Obes 2019 43 4 673 682 10.1038/s41366-018-0227-6 PMC9354568 30337653 · DOI
  42. [42]Nirengi S Fujibayashi M Furuno S Uchibe A Kawase Y Sukino S Kawaguchi Y Minato S Kotani K Sakane N Nonalcoholic Fatty Liver Disease in University Rugby Football Players Front Endocrinol (Lausanne) 2018 9 341 10.3389/fendo.2018.00341 29973915 PMC6019459 · DOI
  43. [43]Oikonomou D Georgiopoulos G Katsi V Kourek C Tsioufis C Alexopoulou A Koutli E Tousoulis D Non-alcoholic fatty liver disease and hypertension: coprevalent or correlated? Eur J Gastroenterol Hepatol 2018 30 9 979 985 10.1097/MEG.0000000000001191 30048367 · DOI
  44. [45]Zheng RD Chen ZR Chen JN Lu YH Chen J Role of body mass index, Waist-to-Height and Waist-to-Hip Ratio in Prediction of Nonalcoholic Fatty Liver Disease Gastroenterol Res Pract 2012 2012 362147 362146 10.1155/2012/362147 22701476 PMC3369513 · DOI
  45. [46]Harsha Varma S Tirupati S Pradeep TVS Sarathi V Kumar D Insulin resistance and hyperandrogenemia independently predict nonalcoholic fatty liver disease in women with polycystic ovary syndrome Diabetes Metab Syndr 2019 13 2 1065 1069 10.1016/j.dsx.2018.12.020 31336445 · DOI

Authors
Xie, F., Pei, Y., Zhou, Q., Cao, D., & Wang, Y.
Affiliations
Nanjing Medical University (CN)
Corresponding author
Xie, Fangfei
ORCID
Venue
Lipids in Health and Disease
Publisher
Springer Science and Business Media LLC
Published
2021-10-10
Volume
20
Issue
1
Pages
132-132
ISSN
1476-511X (ISSN-L)
DOI
10.1186/s12944-021-01560-3
PMC
PMC8502306
OpenAlex
W3206299122
Cited by
34
References
46
Citations by year
2026: 6 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 12
FWCI
4.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Lipids in Health and Disease (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
non-alcoholic fatty liver disease, anthropometric indices, metabolic indices, body roundness index, body mass index, abdominal volume index, atherogenic index of plasma, waist-to-hip ratio, waist-to-height ratio, diagnostic accuracy, Chinese adults
MeSH terms
Adult, Age Factors, Body Weights and Measures, China, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Obesity, ROC Curve, Sex Factors, Body Mass Index, Asian People, Non-alcoholic Fatty Liver Disease

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