Rethinking noninvasive steatosis indices: Structural limitations and misclassification across the body mass index spectrum

doi:10.4254/wjh.v18.i5.118804

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. May 27, 2026; 18(5): 118804
Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.118804

Rethinking noninvasive steatosis indices: Structural limitations and misclassification across the body mass index spectrum

Kengo Moriyama

Kengo Moriyama, Department of Clinical Health Science, Tokai University School of Medicine, Hachioji 192-0032, Tokyo, Japan

Author contributions: Moriyama K conceptualized the editorial, drafted the manuscript, reviewed and revised the content, and approved the final version for submission.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Corresponding author: Kengo Moriyama, MD, PhD, Professor, Department of Clinical Health Science, Tokai University School of Medicine, 1838 Ishikawa-Machi, Hachioji 192-0032, Tokyo, Japan. kengomoriyama@tokai.ac.jp

Received: January 12, 2026
Revised: February 4, 2026
Accepted: April 16, 2026
Published online: May 27, 2026
Processing time: 135 Days and 0.4 Hours

Core Tip

Core Tip: While noninvasive steatosis markers are widely used, their diagnostic accuracy varies across the body mass index spectrum. Their reliance on anthropometric parameters leads to systematic errors, resulting in overestimation of steatosis and underestimation in lean individuals. Consequently, these tools should be utilized in a context-dependent manner, interpreted alongside imaging and metabolic assessments.