title: Influence of Ethnicity on the Accuracy of Non-Invasive Scores Predicting Non-Alcoholic Fatty Liver Disease.
abstract: OBJECTIVE
  Presence of non-alcoholic fatty liver disease (NAFLD) can predict risks for diabetes, cardiovascular disease and advanced liver disease in the general population. We aimed to establish a non-invasive score for prediction of NAFLD in Han Chinese, the largest ethnic group in the world, and detect whether ethnicity influences the accuracy of such a score.
  
  
  METHODS
  Liver fat content (LFAT) was measured by quantitative ultrasound in 3548 subjects in the Shanghai Changfeng Community and a Chinese score was created using multivariate logistic regression analyses. This new score was internally validated in Chinese and externally in Finns. Its diagnostic performance was compared to the NAFLD liver fat score, fatty liver index (FLI) and hepatic steatosis index (HSI) developed in Finns, Italians and Koreans. We also analyzed how obesity related to LFAT measured by 1H-MRS in 79 Finns and 118 Chinese with type 2 diabetes (T2D).
  
  
  RESULTS
  The metabolic syndrome and T2D, fasting serum insulin, body mass index (BMI) and AST/ALT ratio were independent predictors of NAFLD in Chinese. The AUROC in the Chinese validation cohort was 0.76 (0.73-0.78) and in Finns 0.73 (0.68-0.78) (p<0.0001). 43%, 27%, 32% and 42% of Chinese had NAFLD when determined by the Chinese score, NAFLD liver fat score (p<0.001 vs. Chinese score), FLI (p<0.001) and HSI (NS). For any given BMI and waist circumference, the Chinese had a markedly higher LFAT than the Finns.
  
  
  CONCLUSIONS
  The predictors of NAFLD in Han Chinese are as in Europids but the Chinese have more LFAT for any given degree of obesity than Europids. Ethnicity needs to be considered when NAFLD is predicted using risk scores.
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.|Institute of Chronic Metabolic Diseases, Fudan Unversity, Shanghai, China.
authors: Ming-Feng
authors: MF
authors: Xia
authors: Department of Medicine, University of Helsinki, Helsinki, Finland.|Minerva Foundation Institute for Medical Research, Helsinki, Finland.
authors: Hannele
authors: H
authors: Yki-Järvinen
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.|Institute of Chronic Metabolic Diseases, Fudan Unversity, Shanghai, China.
authors: Hua
authors: H
authors: Bian
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.|Institute of Chronic Metabolic Diseases, Fudan Unversity, Shanghai, China.
authors: Huan-Dong
authors: HD
authors: Lin
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.|Institute of Chronic Metabolic Diseases, Fudan Unversity, Shanghai, China.
authors: Hong-Mei
authors: HM
authors: Yan
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.|Institute of Chronic Metabolic Diseases, Fudan Unversity, Shanghai, China.
authors: Xin-Xia
authors: XX
authors: Chang
authors: Department of Medicine, University of Helsinki, Helsinki, Finland.|Minerva Foundation Institute for Medical Research, Helsinki, Finland.
authors: You
authors: Y
authors: Zhou
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.|Institute of Chronic Metabolic Diseases, Fudan Unversity, Shanghai, China.
authors: Xin
authors: X
authors: Gao
mesh_terms: D000368:Aged; D044466:Asian People; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000208:ethnology; D002681:China / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000208:ethnology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000208:ethnology; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000208:ethnology; D012307:Risk Factors; D044465:White People