From fatty liver indices to the Zhejiang University index: Re-shaping risk stratification of metabolic liver disease in diabetes

Table 1 Comparative summary of non-invasive indices for hepatic steatosis and fibrosis assessment.

Index	Type	Formula	Key variables	Diagnostic cut-offs	Typical AUC	Ref.
FLI	Steatosis-related	0.953 × e (0.139 × BMI + 0.718 × ln (TG) + 0.053 × GGT + 0.053 × WC - 15.745)	BMI, TG, GGT, WC	> 60 indicates hepatic steatosis; < 30 rules out	0.82-0.85	Clayton-Chubb et al[6]; Kaneva and Bojko[8]
HSI	Steatosis-related	8 × (ALT/AST) + BMI (+ 2 if female)	ALT, AST, BMI, sex	≥ 36 indicates steatosis; ≤ 30 rules out	0.80-0.83	Liu et al[7]; Chang et al[11]; Ahn[12]
ZJU	Steatosis-related	BMI (kg/m2) + FPG (mmol/L) + TG (mmol/L) + 3 × (ALT/AST) + (+ 2 if female; + 0 if male)	BMI, FPG, TG, ALT, AST, sex	≥ 38 indicates NAFLD	0.84-0.87	Tao et al[1]; Zheng et al[15]
NLFS	Steatosis-related	-2.89 + 1.18 × MS + 0.45 × T2D + 0.15 × FBG + 0.04 × AST - 0.94 × (AST/ALT ratio)	MS, T2D, FBG, AST, ALT	> -0.64 indicates hepatic fat accumulation	0.83-0.86	Clayton-Chubb et al[6]; Liu et al[7]
FIB-4	Fibrosis-related	[Age (years) × AST (U/L)]/[platelet count (109/L) × √ALT (U/L)]	Age, AST, ALT, platelet count	< 1.3 (low fibrosis); 1.3-2.67 (indeterminate); > 2.67 (advanced fibrosis)	0.85-0.88	Cusi et al[18]
NFS	Fibrosis-related	-1.675 + 0.037 × age + 0.094 × BMI + 1.13 × IFG/T2D + 0.99 × (AST/ALT ratio) - 0.013 × PLT - 0.66 × albumin	Age, BMI, AST, ALT, PLT, albumin, IFG/T2D	< -1.455 (low fibrosis); > 0.676 (advanced fibrosis)	0.84-0.87	Clayton-Chubb et al[6]; Liu et al[7]; Ahn[12]; Zhang et al[13]

AUC: Area under the curve; FLI: Fatty liver index; HSI: Hepatic steatosis index; NLFS: Non-alcoholic fatty liver disease-liver fat score; FIB-4: Fibrosis-4; NFS: Non-alcoholic fatty liver disease fibrosis score; ZJU index: Zhejiang University index; BMI: Body mass index; FPG: Fasting plasma glucose; TG: Triglyceride; GGT: Gamma-glutamyl transferase; WC: Waist circumference; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; MS: Metabolic syndrome; T2D: Type 2 diabetes; FBG: Fasting blood glucose; PLT: Platelet count; IFG: Impaired fasting glucose; NAFLD: Non-alcoholic fatty liver disease.