Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis

Table 1 Indexes for the prediction of liver steatosis

Index	Author(nation)	Paper (yr)	No. of subjects(fatty liver/ non-fatty liver)	Parameters	Cutoff values	Sens-itivity	Speci-ficity	AUROC	Diagnostic methods for hepatic steatosis
FLI	Bedogni(Italy)	BMC Gastroenterology (2006)	228/268	BMI, waist circumference, triglyceride, γGT	< 30 > 60	87.0%61.0%	64.0%86.0%	0.84	US
NAFLD liver fat score1	Kontronen(Finland)	Gastroenterology (2009)	470	MetS, type II diabetes, IRI, AST, AST/ALT ratio	-0.64	86.0%	71.0%	0.8720.863	MRS
HSI	Lee (South Korea)	Dig Liver Dis (2010)	5362/5362 (sex- and age- matched)	8 × AST/ALT ratio + BMI + (+ 2 for females, + 2 for diabetes)	< 30 > 36	93.1%	92.4%	0.812	US
ST	Poynaud(France)	Comp Hepatol(2005)	744/140	12 parameters4	0.30 0.72	90%	90.0%	0.7920.8030.8630.723	Biopsy
	Park (South Korea)	Korean J Hepatol(2011)	145/311	ALT/AST > 1.5 (= 1 point)γGT > 50 IU/L (= 1 point)TG > 150 mg/dL (= 1 point)BMI 23-24.9 (= 2 points) ≥ 25 (= 3 points)	3	71.7%	75.9%	0.797	US
	Bajaj(India)	Indian J Med Res (2009)	39/82	IRI +1.6 × BMI + 1.9 × FPG	1.6	84.6%	76.0%	0.76	US

¹PNPLA3 did not improve diagnostic accuracies;

²Estimation group;

³Validation group;

⁴Alanine aminotransferase (ALT), α2-macroglobulin, apolipoprotein A-I, haptoglobin, total bilirubin, γ-glutamyl transferase (γGT), cholesterol, triglycerides, glucose, age, gender and body mass index (BMI). ROC: Receiver operating characteristics curve; US: Ultrasonography; MetS: Metabolic syndrome; MRS: Magnetic resonance spectroscopy, IRI: Immuno-reactive insulin; FPG: Fasting plasma glucose. FLI: Fatty liver index; HSI: Hepatic steatosis index; ST: Steato Test; AST: Aspartate aminotransferase; NAFLD: Nonalcoholic fatty liver disease; AUROC: Area under the receiver operating characteristic curve.