Performance of three clinical scores for steatosis and steatohepatitis and their interaction with metabolic syndrome in obese individuals
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND Non-invasive clinical scores are widely used to detect hepatic steatosis and steatohepatitis, but their accuracy in individuals with obesity is limited. Most of these tools were developed for non-obese populations and do not account for metabolic dysfunction-associated steatotic liver disease (MASLD) spectrum. Moreover, the potential modifying effect of metabolic syndrome (MetS) on the diagnostic performance of these scores remains unclear. Given the global burden of obesity and MASLD, there is a pressing need to refine diagnostic strategies for early detection. We hypothesized that diagnostic performance may vary by MetS status and can be improved with adjusted thresholds. AIM To evaluate and optimize three clinical scores for steatosis and metabolic dysfunction-associated steatohepatitis (MASH), including assessment by MetS status. METHODS This cross-sectional study included 95 individuals undergoing bariatric surgery at a hospital in Brazil. Clinical scores [non-alcoholic fatty liver disease liver fat score (NLFS), hepatic steatosis index (HSI), and fatty liver index (FLI)] were calculated from preoperative data. Liver biopsy was used as the reference standard to assess steatosis and MASH. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve, and optimal cut-offs were determined by Youden’s index. Logistic regression with interaction terms assessed whether MetS modified the diagnostic performance of each score across histological outcomes. RESULTS Sixty-six individuals (69.5%) had steatosis, and fifteen (15.8%) had moderate-to-severe steatosis and MASH. The area under the receiver operating characteristic curves for any steatosis was 0.676 (NLFS), 0.540 (HSI), and 0.468 (FLI); for moderate-to-severe steatosis, 0.671 (NLFS), 0.659 (HSI), and 0.700 (FLI); and for MASH, 0.671 (NLFS), 0.625 (HSI), and 0.639 (FLI). Standard cut-offs performed poorly; optimized thresholds improved both sensitivity and specificity. NLFS outperformed FLI for any steatosis (P = 0.021). No significant interactions were found between MetS and any score (all P > 0.05), indicating that diagnostic accuracy did not significantly differ by MetS status. CONCLUSION NLFS, HSI, and FLI show limited accuracy in obese individuals. Adjusting thresholds improves performance. Diagnostic utility remains consistent regardless of MetS, supporting their use across the MASLD spectrum.
Source: World Journal of Hepatology
Authors: Giovani Schulte Farina, Bárbara Brambilla, Emanuelle Mendonça Pandolfo, Laura Kalil Nader Lazzaretti, Stéfano Mateus Schio Kuiava, Ana Maria Graciolli, Vitória Maria Kriger, Carlos Henrique Dal Bem Fistarol, Augusto Cardoso Sgarioni, Henrique Prataviera Giovanardi, Aline Caldart Tregnago, Floriano Riva, Cassiano da Silva Scholze, Daniel Cecconi Agostini, Bruno Dellamea, Arturo Tamayo, Tiago Lemos Cerqueira, Jonathan Soldera, Ben Min-Woo Illigens
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7128646056