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Vol. 22.
(May - June 2021)
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Vol. 22.
(May - June 2021)
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DOI: 10.1016/j.aohep.2020.100301
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Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures
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Lingzhen Jin, Xiaofei Li
Corresponding author
icqwc46@163.com

Corresponding author.
Department of Infectious Diseases, Yiwu Central Hospital, Zhejiang 322000, China
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Ann Hepatol. 2021;22C:10.1016/j.aohep.2021.100335
Monica C. Preciado-Puga, Yeniley Ruiz-Noa, Juana R. Garcia-Ramirez, Benjamin Jordan-Perez, Serafin Garnelo-Cabañas, Maria L. Lazo de la Vega-Monroy, Karen I. Gutierrez-Aguirre, Lorena R. Ibarra-Reynoso
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Dear Editor,

Puga et al. recently published an intriguing study entitled “Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures” in Annals of Hepatology [1]. The results of this cross-sectional study provided evidence for the clinical diagnosis of Non-Alcoholic Fatty Liver Disease (NAFLD). Although we fully agree with the conclusions of this study, the association between body mass index (BMI) and NAFLD needs to be highlighted.

Defined as weight (kg)/height (m)2, BMI [2,3] is a crucial marker widely adopted in clinical practice to judge obesity (BMI ≥ 30 kg/m2) [4]. Further, considering that the indicators (weight and height) for calculating BMI can be easily obtained from medical record systems, BMI is extensively applied in clinical decision-making, including NAFLD. A cohort study based on community population found that BMI is a significant factor in predicting the occurrence of NAFLD, implying that clinicians could use BMI to judge the probability of NAFLD occurrence [5]. Further evidence from Australia has similarly suggested that obese people have a higher incidence of NAFLD [6]. The above evidence indicates that BMI or obesity is closely related to the occurrence of NAFLD. As detailed in Table 1 of the study of Puga et al. [1], patients with NAFLD have significantly higher BMI levels than those without NAFLD (30.96 ± 4.71 versus 27.81 ± 5.26, P = 0.025). Hence, BMI could be a vital confounding factor in exploring whether clinical indices and hepatic ultrasound measurements can improve the diagnostic accuracy of NAFLD. In our opinion, performing subgroup analysis premised on the BMI value or conducting regression analysis to adjust BMI might help to obtain reliable conclusions.

Declaration of funding interests

None.

Conflict of interest

The authors have no conflict of interest to declare.

References
[1]
M.C. Preciado-Puga, Y. Ruiz-Noa, J.R. Garcia-Ramirez, B. Jordan-Perez, S. Garnelo-Cabañas, M.L. Lazo de la Vega-Monroy, et al.
Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures.
[2]
D. Bann, W. Johnson, L. Li, D. Kuh, R. Hardy.
Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies.
Lancet Public Health, 3 (2018), pp. e194-e203
[3]
Z. Cui, J. Stevens, K.P. Truesdale, D. Zeng, S. French, P. Gordon-Larsen.
Prediction of body mass index using concurrently self-reported or previously measured height and weight.
[4]
C. Caussy, F. Pattou, F. Wallet, C. Simon, S. Chalopin, C. Telliam, et al.
Prevalence of obesity among adult inpatients with COVID-19 in France.
Lancet Diabetes Endocrinol, 8 (2020), pp. 562-564
[5]
T. Miyake, T. Kumagi, M. Hirooka, S. Furukawa, M. Koizumi, Y. Tokumoto, et al.
Body mass index is the most useful predictive factor for the onset of nonalcoholic fatty liver disease: a community-based retrospective longitudinal cohort study.
J Gastroenterol, 48 (2013), pp. 413-422
[6]
G.J. Ooi, P.R. Burton, J. Bayliss, A. Raajendiran, A. Earnest, C. Laurie, et al.
Effect of body mass index, metabolic health and adipose tissue inflammation on the severity of non-alcoholic fatty liver disease in bariatric surgical patients: a prospective study.
Obes Surg, 29 (2019), pp. 99-108
Copyright © 2020. Fundación Clínica Médica Sur, A.C.
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