Burden of nonalcoholic fatty liver disease and advanced fibrosis in a Texas Hispanic community cohort

Table 1 Formulae and cut-off scores of diagnostic panels for detection of liver fibrosis

Diagnostic panel	Formula	Cut-off scores for advanced fibrosis
		Absent	Present
BARD score[8]	Scale 0-4		≥ 2
	BMI ≥ 28 kg/m2 = 1 point
	AST/ALT ratio ≥ 0.8 = 2 points
	DM = 1 point
FIB4 index[9]	Age (yr) × AST (U/L)]/(platelet (109) × [ALT (U/L)]1/2	< 1.3	> 2.67
APRI[10]	(AST/ULN)/platelets (109/L) × 100	≤ 0.5	> 1.5
NAFLD fibrosis score[15]	-1.675 + 0.037 × age (yr) + 0.094 × BMI	< -1.455	> 0.676
	(kg/m2) + 1.13 × IFG/DM (yes = 1, no = 0)
	+ 0.99 × AST/ALT ratio - 0.013 × platelet
	(× 109/L) - 0.66 × albumin (g/dL)

BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ULN: Upper limit of normal; DM: Diabetes mellitus; IFG: Impaired fasting glucose; NAFLD: Nonalcoholic fatty liver disease.

Table 2 Summary of the characteristics of participants (n = 442)

Characteristics
Age (yr)	49.1 ± 14.2
Gender
Female	290 (65.6)
Male	152 (34.4)
BMI (kg/m2)	31.3 ± 6.1
Hepatic steatosis	230 (52.0)
Elevated ALT1	128 (29.0)
Elevated AST2	129 (29.2)
Albumin (g/dL)	4.0 (3.8-4.2)
Platelet (109/μL)	243.5 (207.0-282.0)
DM3	97 (21.9)
Hypertension	167 (37.8)
Hyperglycemia	134 (30.3)
Hypertriglyceridemia	175 (39.6)
Low HDL-C	267 (60.4)
Central obesity	324 (73.3)
Metabolic syndrome	219 (49.5)
NAFLD fibrosis score
< -1.455	244 (55.2)
-1.455-0.676	169 (38.2)
> 0.676	29 (6.6)
FIB4 index
≤ 1.31	323 (73.1)
1.31-2.66	106 (24.0)
≥ 2.67	13 (2.9)
BARD
0-1	163 (36.9)
2-4	279 (63.1)
APRI
≤ 0.5	365 (82.6)
0.51-1.5	73 (16.5)
> 1.5	4 (0.9)

Table 3 Comparison of the characteristics of participants with and without hepatic steatosis

Characteristics	Hepatic steatosis		P value
	Absent (n = 212)	Present (n = 230)
Age (yr)	49.5 ± 16.3	48.7 ± 12.0	0.6
Gender
Female	134 (63.2)	156 (67.8)
Male	78 (36.8)	74 (32.2)	0.3
BMI (kg/m2)	29.6 ± 6.1	32.9 ± 5.6	< 0.001
Elevated ALT1	31 (14.6)	97 (42.2)	< 0.001
Elevated AST2	40 (18.9)	89 (38.7)	< 0.001
Albumin (g/dL)	4.0 (3.8-4.2)	4.0 (3.9-4.2)	0.4
Platelets (109/μL)	237.5 (204.0-277.8)	251.0 (214.0-283.5)	0.1
DM3	29 (13.7)	68 (29.6)	< 0.001
Hypertension	72 (34.0)	95 (41.3)	0.1
Hyperglycemia	38 (17.9)	96 (41.7)	< 0.001
Hypertriglyceridemia	67 (31.6)	108 (47.0)	0.001
Low HDL-C	105 (49.5)	162 (70.4)	< 0.001
Central obesity	125 (59.0)	199 (86.5)	< 0.001
Metabolic syndrome	70 (33.0)	149 (64.8)	< 0.001
NAFLD Fibrosis Score
< -1.455	134 (63.2)	110 (47.8)
-1.455-0.676	63 (29.7)	106 (46.1)
> 0.676	15 (7.1)	14 (6.1)	0.002
FIB4 index
≤ 1.3	157 (74.1)	166 (72.2)
1.31-2.66	47 (22.2)	59 (25.7)
≥ 2.67	8 (3.8)	5 (2.2)	0.46
BARD
0-1	79 (37.3)	84 (36.5)
2-4	133 (62.7)	146 (63.5)	0.87
APRI
≤ 0.5	190 (89.6)	175 (76.1)
0.51-1.5	22 (10.2)	51 (22.2)
> 1.5	0 (0)	4 (1.7)	0.0024

Age and BMI are described as mean ± SD. Categorical variables are described as frequency (%).

¹ALT > 40 U/L for men and > 31 U/L for women;

²AST > 37 U/L for men and > 31 U/L for women;

³Either history of diabetes mellitus, use medication for diabetes mellitus, fasting plasma glucose ≥ 126 mg/dL, or glycosylated hemoglobin A1C ≥ 6.5 g/dL;

⁴χ² with Yate’s correction is computed. BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; DM: Diabetes mellitus; HDL-C: High-density lipoprotein cholesterol; APRI: AST to platelet ratio index; NAFLD: Nonalcoholic fatty liver disease.

Table 4 Univariable and multivariable analysis of the characteristics associated with fatty liver on ultrasound

	Univariable analysis			Multivariable analysis
Characteristics	OR	95%CI for OR	P value	OR1	95%CI for OR1	P value
Age (yr)	0.99	0.98-1.01	0.55
Male gender	0.81	0.55-1.21	0.31
BMI (kg/m2)	1.11	1.07-1.15	< 0.0001
Elevated ALT1	4.26	2.68-6.76	< 0.0001	4.04	2.50-6.52	< 0.0001
Elevated AST2	2.71	1.76-4.19	< 0.0001	2.63	1.67-4.13	< 0.0001
Albumin (g/dL)	1.26	0.65-2.45	0.49	2.29	1.07-4.88	0.03
Platelets (109/μL)	1.00	0.99-1.01	0.14	1.00	0.99-1.00	0.55
DM3	2.65	1.63-4.29	0.0001	2.22	1.31-3.77	0.003
Hypertension	1.37	0.93-2.01	0.11	1.18	0.72-1.82	0.45
Hyperglycemia	3.28	2.12-5.08	< 0.0001	2.87	1.78-4.61	< 0.0001
Hypertriglyceridemia	1.92	1.30-2.83	0.001	1.82	1.21-2.75	0.004
Low HDL-C	2.43	1.64-3.59	< 0.0001	1.93	1.28-2.93	0.002
Central obesity	4.47	2.80-7.13	< 0.0001	3.52	1.94-6.39	< 0.0001
Metabolic syndrome	3.73	2.52-5.53	< 0.0001	3.33	2.07-5.01	< 0.0001
NAFLD fibrosis score
< -1.455	1.00			1.00
-1.455-0.676	2.05	1.37-3.06	0.0005	1.83	1.10-3.04	0.02
> 0.676	1.14	0.53-2.46	0.74	0.58	0.22-1.56	0.28
FIB4 index
≤ 1.3	1.00			1.004
1.31-2.66	1.19	0.76-1.85	0.45	1.404	0.83-2.39	0.21
≥ 2.67	0.59	0.19-1.85	0.37	0.694	0.19-2.47	0.57
BARD
0-1	1.00			1.004
2- 4	1.03	0.70-1.52	0.87	1.004	0.65-1.52	0.99
APRI
≤ 0.5	1.00			1.004
0.51-1.5	2.52	1.47-4.32	0.0008	2.624	1.49-4.60	0.0008
> 1.5	-	-	-	-	-	-

¹ALT > 40 U/L for men and > 31 U/L for women;

²AST > 37 U/L for men and > 31 U/L for women;

³Either history of diabetes mellitus, use medication for diabetes mellitus, fasting plasma glucose ≥ 126 mg/dL, or glycosylated hemoglobin A1C ≥ 6.5 g/dL;

⁴Adjusted for age, gender, and BMI. BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; DM: Diabetes mellitus; HDL-C: High-density lipoprotein cholesterol; APRI: AST to platelet ratio index; NAFLD: Nonalcoholic fatty liver disease.