The ZJU index is a powerful surrogate marker for NAFLD in severely obese North American women

Autoři: Chia-Po Fu aff001;  Hira Ali aff004;  Vikrant P. Rachakonda aff005;  Elizabeth A. Oczypok aff004;  James P. DeLany aff006;  Erin E. Kershaw aff004
Působiště autorů: Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan aff001;  Department of Medicine, Chung Shan Medical University, Taichung, Taiwan aff002;  Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering and Computer Science, National Taiwan University, Taipei, Taiwan aff003;  Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America aff004;  Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America aff005;  Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, United States of America aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224942



Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the western world and is highly associated with multiple cardiometabolic complications. The Zhejiang University (ZJU) index was first developed to predict NAFLD in Chinese populations, where it was shown to have better predictive value than other currently used indices. The aims of the present study were to 1) determine the diagnostic accuracy of ZJU index in identifying NAFLD in a well-phenotyped cohort of obese middle-aged American women and 2) compare its performance with other non-invasive indices for NAFLD identification.


To achieve this goal, we performed a retrospective analysis of a prospectively-collected cohort of participants enrolled in a weight loss trial for severe obesity (RENEW, identifier: NCT00712127). One hundred and seven women between the age of 30 and 55 with obesity class II (BMI 35–39.9 kg/m2) or class III (BMI ≥ 40 kg/m2) were recruited for analyses. Hepatic steatosis was measured using liver/spleen attenuation ratio (L/S ratio) from unenhanced abdominal computed tomography. Beside ZJU index, hepatic steatosis index (HSI), lipid accumulation production index (LAPI), and visceral adiposity index (VAI) were also determined and to compare their performance in predicting NAFLD.


Of 107 obese women in the study, 40 (37.4%) met imaging criteria for NAFLD using cut-off value of L/S ratio < 1.1. The ZJU index was positively correlated with HIS, LAPI, but not VAI. The area under the curve was highest for the ZJU index (AUC = 0.742, 95% CI:0.647–0.837), followed by HSI (AUC = 0.728, 95% CI:0.631–0.825), LAPI (AUC = 0.682, CI:0.583–0.781), and VAI (AUC = 0.621, 95% CI:0.518–0.725), respectively, using the Youden method.


The ZJU index is a powerful surrogate marker for NAFLD in severely obese western females and its predictive value was better than that of other commonly used indices for predicting NAFLD. Our study is the first to suggest that the ZJU index could be a promising model for use in western as well as Chinese populations.

Klíčová slova:

Adipose tissue – Biopsy – Body Mass Index – Computed axial tomography – Fatty liver – Lipids – Obesity – Steatosis


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Článek vyšel v časopise


2019 Číslo 11