A Nomogram Model Based on Noninvasive Bioindicators to Predict 3-Year Risk of Nonalcoholic Fatty Liver in Nonobese Mainland Chinese: A Prospective Cohort Study.

Xintian Cai,Nanfang Li,Yuanyuan Cao,Ayguzal Ahmat,Xiayire Aierken,Qing Zhu,Ting Wu,Marcello Maida

doi:10.1155/2020/8852198

Abstract

The purpose of this study is to establish and validate an accurate and personalized nonalcoholic fatty liver disease (NAFLD) prediction model based on the nonobese population in China. This study is a secondary analysis of a prospective study. We included 6,155 nonobese adults without NAFLD at baseline, with a median follow-up of 2.3 years. Univariate and multivariate Cox regression analyses were used to determine independent predictors. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize the selection of variables. Based on the results of multivariate analysis, a prediction model was established. Harrell's consistency index (C-index) and area under the curve (AUC) were used to determine the discrimination of the proposed model. The goodness of fit of the calibration model was tested, and the clinical application value of the model was evaluated by decision curve analysis (DCA). The participants were randomly divided into a training cohort (n = 4,605) and a validation cohort (n = 1,550). Finally, seven of the variables (HDL-c, BMI, GGT, ALT, TB, DBIL, and TG) were included in the prediction model. In the training cohort, the C-index and AUC value of this prediction model were 0.832 (95% confidence interval (CI), 0.820-0.844) and 0.861 (95% CI, 0.849-0.873), respectively. In the validation cohort, the C-index and AUC values of this prediction model were 0.829 (95% CI, 0.806-0.852) and 0.859 (95% CI, 0.841-0.877), respectively. The calibration plots demonstrated good agreement between the estimated probability and the actual observation. DCA demonstrated a clinically effective predictive model. Our nomogram can be used as a simple, reasonable, economical, and widely used tool to predict the 3-year risk of NAFLD in nonobese populations in China, which is helpful for timely intervention and reducing the incidence of NAFLD.

Highlights

Nonalcoholic fatty liver disease (NAFLD) is a metabolic stress liver injury closely related to insulin resistance (IR) and genetic susceptibility [1]
The clinical burden of NAFLD is not limited to liver-related morbidity and mortality, and increasingly evidence shows that NAFLD is closely related to the high incidence of metabolic syndrome (Mets), type 2 diabetes, arteriosclerotic cardiovascular disease, chronic kidney disease, and colorectal tumor [5,6,7]
BioMed Research International nonobese NAFLD individuals may represent a subset of NAFLD in metabolically obese but normal-weight individuals, and their metabolic abnormalities are similar to those associated with obesity [12]

Summary

Introduction

Nonalcoholic fatty liver disease (NAFLD) is a metabolic stress liver injury closely related to insulin resistance (IR) and genetic susceptibility [1]. BioMed Research International nonobese NAFLD individuals may represent a subset of NAFLD in metabolically obese but normal-weight individuals, and their metabolic abnormalities are similar to those associated with obesity [12]. These patients showed high incidence rate of cardiovascular disease, diabetes, and allcause mortality, which makes it an enormous health burden [13,14,15]. Despite the lack of pharmacological therapy, there are effective lifestyle interventions such as dietary changes, increased physical activity, and energy restriction [16] These interventions are effective in the early stages of the disease. The current challenge is how to identify these high-risk groups

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