title: Comparison of liver fat indices for the diagnosis of hepatic steatosis and insulin resistance.
abstract: BACKGROUND
  Hepatic steatosis, defined as increased hepatocellular lipid content (HCL), associates with visceral obesity and glucose intolerance. As exact HCL quantification by 1H-magnetic resonance spectroscopy (1H-MRS) is not generally available, various clinical indices are increasingly used to predict steatosis.
  
  
  OBJECTIVE
  The purpose of this study was to test the accuracy of NAFLD liver fat score (NAFLD-LFS), hepatic steatosis index (HSI) and fatty liver index (FLI) against 1H-MRS and their relationships with insulin sensitivity and secretion.
  
  
  METHODS
  Ninety-two non-diabetic, predominantly non-obese humans underwent clinical examination, 1H-MRS and an oral glucose tolerance test (OGTT) to calculate insulin sensitivity and β-cell function. Accuracy of indices was assessed from the area under the receiver operating characteristic curve (AROC).
  
  
  RESULTS
  Median HCL was 2.49% (0.62;4.23) and correlated with parameters of glycemia across all subjects. NAFLD-LFS, FLI and HSI yielded AROCs of 0.70, 0.72, and 0.79, respectively, and related positively to HCL, insulin resistance, fasting and post-load β-cell function normalized for insulin resistance. Upon adjustment for age, sex and HCL, regression analysis revealed that NAFLD-LFS, FLI and HSI still independently associated with both insulin sensitivity and β-cell function.
  
  
  CONCLUSIONS
  The tested indices offer modest efficacy to detect steatosis and cannot substitute for fat quantification by 1H-MRS. However, all indices might serve as surrogate parameters for liver fat content and also as rough clinical estimates of abnormal insulin sensitivity and secretion. Further validation in larger collectives such as epidemiological studies is needed.
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany; Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Kahl
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Straßburger
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany; Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Nowotny
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Roshan
authors.initials: R
authors.lastname: Livingstone
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Klüppelholz
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Keßel
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Jong-Hee
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Institute for Biometrics and Epidemiology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Giani
authors.affiliation: IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hoffmann
authors.affiliation: National Research Council, Institute of Biomedical Engineering, Metabolic Unit, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pacini
authors.affiliation: National Research Council, Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Amalia
authors.initials: A
authors.lastname: Gastaldelli
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine University, Düsseldorf, Germany; Department of Endocrinology and Diabetology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research, Partner Düsseldorf, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Roden
mesh_terms: D050154:Adiposity; D000428:Alcohol Drinking; D005234:Fatty Liver / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000473:pathology; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged
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