Informative value of calculated indices of liver steatosis in patients with non-alcoholic fatty liver disease and postmenopausal obesity

The aim. to study the diagnostic characteristics of liver steatosis assessment indices in patients with non-alcoholic fatty liver disease (NAFLD) and postmenopausal obesity. Materials and methods. 88 postmenopausal women were examined, of whom 70 with an average age of 51.0 (49.0-52.0) years had NAFLD and pre-obesity/obesity and 18 with an average age of 50.5 (48.0-51.0) years without obesity and liver pathology. Waist size was measured in all women, body mass index was calculated, the level of transaminases, gamma-glutamyltranspeptidase and triglycerides were determined, and the steatosis indices HSI (Hepatic steatosis index) and FLI (Fatty liver index) were calculated. Verification of liver steatosis was performed by ultrasound examination. The ROC curve method was used to determine the threshold values and calculate the diagnostic characteristics of the models. Results. During the ROC analysis, the threshold value of the HSI index in patients with NAFLD was 30.5 with sensitivity and specificity of 98.5% and 97.3%, respectively. The predictor value of the FLI index for determining the risk of steatosis in this risk group was 35 (sensitivity 72.2%, specificity 100%). Conclusion. The calculated HSI and FLI indices are quite informative methods for diagnosing a high risk of steatosis in women with pre-obesity and postmenopausal obesity.

non-alcoholic fatty liver disease, liver steatosis, menopause, obesity, steatosis index, FLI, HIS

1. Younossi Z.M., Koenig A.B., Abdelatif D., Fazel Y., Henry L., Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul;64(1):73-84. doi: 10.1002/hep.28431.

2. Sayaf K., Gabbia D., Russo F.P., De Martin S. The Role of Sex in Acute and Chronic Liver Damage.Int J Mol Sci. 2022;23(18):10654. doi: 10.3390/ ijms231810654.

3. Livzan M.A., Syrovenko M.I., Krolevets T.S. Non-alcoholic fatty liver disease and women’s health. breast cancer. Medical review. 2023;7(5):310-317. (In Russ.) doi: 10.32364/2587-6821-2023-7-5-9.@@ Ливзан М.А., Сыровенко М.И., Кролевец Т.С. Неалкогольная жировая болезнь печени и женское здоровье. РМЖ. Медицинское обозрение. 2023;7(5):310-317. doi: 10.32364/2587-6821-2023-7-5-9.

4. Bulatova I.A., Shevlyakova T.P. Features of the course of non-alcoholic fatty liver disease in women at different age periods: a review of the literature. Medical advice. 2024;18(8):90-95. (In Russ.) doi: 10.21518/ms2024-112.@@ Булатова ИА, Шевлюкова ТП. Особенности течения неалкогольной жировой болезни печени у женщин в разные возрастные периоды: обзор литературы. Медицинский совет. 2024;18(8):90-95. doi: 10.21518/ms2024-112.

5. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Diabetologia. 2016 Jun;59(6):1121-40. doi: 10.1007/s00125-016-3902-y.

6. Lazebnik L.B., Golovanova E.V., Turkina S.V.et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Experimental and Clinical Gastroenterology. 2021;1(1):4-52. (In Russ.) doi: 10.31146/1682-8658-ecg-185-1-4-52.@@ Лазебник Л.Б., Голованова Е.В., Туркина С.В. и др. Неалкогольная жировая болезнь печени у взрослых: клиника, диагностика, лечение. Рекомендации для терапевтов, третья версия. Экспериментальная и клиническая гастроэнтерология. 2021;1(1):4-52. doi: 10.31146/1682-8658-ecg-185-1-4-52.

7. Petzol G. Role of Ultrasound Methods for the Assessment of NAFLD. J. Clin. Med. 2022; 11 (15): 4581. doi: 10.3390/jcm11154581.

8. Bulatova I.A., Shchekotova A.P., Paducheva S.V., Gulyaeva I.L., Sobol A.A. Etiopathogenesis and possibilities of minimally invasive diagnosis of chronic diffuse liver diseases: literature review. Therapy. 2023; 9(10): 123-131. (In Russ.) doi: 10.18565/therapy.2023.10.123-131.@@ Булатова И.А., Щекотова А.П., Падучева С.В., Гуляева И.Л, Соболь А.А. Этиопатогенез и возможности малоинвазивной диагностики хронических диффузных заболеваний печени: обзор литературы. Терапия. 2023; 9(10): 123-131. doi: 10.18565/therapy.2023.10.123-131.

9. Bedogni G., Bellentani S., Miglioli L., Masutti F., Passalacqua M., Castiglione A., Tiribelli C. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006 Nov 2;6:33. doi: 10.1186/1471-230X-6-33.

10. Lee J.H., Kim D., Kim H.J. et al. Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis. 2010 Jul;42(7):503-8. doi: 10.1016/j.dld.2009.08.002.

11. Zhirkov I. I., Gordienko A.V., Pavlovich I.M., Golofeevsky V.Yu., Makoveeva O.V. Noninvasive methods of diagnosis of steatosis in non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2020;177(5): 61-66. (In Russ.) doi: 10.31146/1682-8658-ecg-177-5-61-66.@@ Жирков И.И., Гордиенко А.В., Павлович И.М., Голофеевский В.Ю., Маковеева О.В. Неинвазивные методы диагностики стеатоза при неалкогольной жировой болезни печени. Экспериментальная и клиническая гастроэнтерология. 2020;177(5): 61-66. doi: 10.31146/1682-8658-ecg-177-5-61-66.

12. Asadullina Z.R., Sineglazova A.V. Calculated indices of liver steatosis in the practice of a primary care physician. Practical medicine. 2023; 21(6) (In Russ.)@@ Асатуллина З.Р., Синеглазова А.В. Расчетные индексы стеатоза печени в практике врача первичного звена. Практическая медицина. 2023; 21(6)

13. Miftakhova A.M., Bulatova I.A., Gulyaeva I.L. [The use of calculated indices in the diagnosis of non-alcoholic steatosis and viral liver fibrosis]. Collection of scientific articles based on the results of the International Scientific Forum “Science and Innovation-Modern concepts”. August 13, 2021. Moscow. pp. 42-48. (In Russ.)@@ Мифтахова А.М., Булатова И.А., Гуляева И.Л. Использование расчетных индексов в диагностике неалкогольного стеатоза и вирусного фиброза печени. Сборник научных статей по итогам работы Международного научного форума «Наука и инновации-Современные концепции». 13 августа 2021 г. (г. Москва): 42-48.

14. Palmentieri B., de Sio I., La Mura V., Masarone M., Vecchione R., Bruno S., Torella R., Persico M. The role of bright liver echo pattern on ultrasound B-mode examination in the diagnosis of liver steatosis. Dig Liver Dis. 2006 Jul;38(7):485-9. doi: 10.1016/j.dld.2006.03.021.

15. Statsenko M.E., Turkina S.V., Kosivtsova M.A., Shilina N.N. Noninvasive diagnosis of non-alcoholic fatty liver disease: simple “tools” are already in the hands of a practical doctor. To help a practical doctor. 2019; 2 (70): 134-139. (In Russ.) doi: 10.19163/1994-9480-2019-2(70)-134-139.@@ Стаценко М.Е., Туркина С.В., Косивцова М.А., Шилина Н.Н. Неинвазивная диагностика неалкогольной жировой болезни печени: простые «инструменты» уже в руках практического врача. В помощь практическому врачу. 2019; 2 (70): 134-139. doi: 10.19163/1994-9480-2019-2(70)-134-139.

16. Tarasova L.V., Tsyganova Yu.V., Opalinskaya I.V., Ivanova A.L. Overview of laboratory diagnostic methods used in nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) at the modern stage. Experimental and Clinical Gastroenterology. 2019;(4):72-77. (In Russ.) doi: 10.31146/1682-8658-ecg-164-4-72-77.@@ Тарасова Л.В., Цыганова Ю.В., Опалинская И.В., Иванова А.Л. Обзор методов лабораторной диагностики, применяемых при неалкогольной жировой болезни печени (НАЖБП) и алкогольной болезни печени (АБП) на современном этапе. Экспериментальная и клиническая гастроэнтерология. 2019;(4):72-77. doi: 10.31146/1682-8658-ecg-164-4-72-77.