{
  "abstract": "Objectives Early screening of non-alcoholic fatty liver disease (NAFLD) is critical for early diagnosis and management. The disease was renamed and its diagnostic criteria revised as metabolic-associated FLD (MAFLD) in 2020 and further updated to metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. This study evaluated the predictive performance and clinical feasibility of non-invasive diagnostic indicators across the NAFLD, MAFLD and MASLD diagnostic criteria.Design Cross-sectional study.Setting Health Management Centre in China.Participants A total of 5810 participants aged ≥18 years were enrolled. Individuals with missing laboratory data, imaging results or self-reported information were excluded.Primary and secondary outcome measures Disease-specific indicators included Fatty Liver Index (FLI), Hepatic Steatosis Index and Zhejiang University index (ZJU). Non-disease-specific indicators included lipid accumulation product (LAP), Visceral Adiposity Index and the Triglyceride and Glucose Index. Subgroup analysis was performed by gender and Body Mass Index (BMI).Results The area under the receiver operating characteristic curve (AUROC) for all six non-invasive indicators exceeded 0.7. FLI showed the optimal predictive performance across the three criteria (NAFLD-AUROC: 0.802, MAFLD-AUROC: 0.847 and MASLD-AUROC: 0.811), with comparable performance observed for ZJU (0.797, 0.838 and 0.809, respectively). Pairwise z-tests demonstrated a significant difference between FLI and ZJU for MAFLD (p<0.05), but not for NAFLD or MASLD (all p>0.05). Subgroup analyses revealed that ZJU performed better in males (NAFLD-AUROC: 0.790, MAFLD-AUROC: 0.839 and MASLD-AUROC: 0.803), while FLI was superior in females (NAFLD-AUROC: 0.832, MAFLD-AUROC: 0.838 and MASLD-AUROC: 0.838) and in participants who were overweight (NAFLD-AUROC: 0.709, MAFLD-AUROC: 0.765 and MASLD-AUROC: 0.709). LAP exhibited the highest predictive efficacy in the normal BMI subgroup (NAFLD-AUROC: 0.758, MAFLD-AUROC: 0.804 and MASLD-AUROC: 0.796).Conclusions FLI exhibited the highest predictive efficacy across all diagnostic criteria, and ZJU showed comparable performance. Considering diagnostic accuracy and clinical practicality, ZJU is recommended as a favourable, non-invasive tool for population-based screening in the Chinese population.",
  "authors": [
    {
      "affiliations": [
        "Xiangya School of Nursing, Central South University, Changsha, Hunan, China",
        "Health Management Medicine Center and Nursing Department, Third Xiangya Hospital of Central South University, Changsha, Hunan, China"
      ],
      "name": "Xin-Yun Tan"
    },
    {
      "affiliations": [
        "School of Nursing, Jishou University, Jishou, Hunan, China"
      ],
      "name": "Hui-Hui Zou"
    },
    {
      "affiliations": [
        "Xiangya School of Nursing, Central South University, Changsha, Hunan, China"
      ],
      "name": "Xinjuan Huang"
    },
    {
      "affiliations": [
        "Xiangya School of Nursing, Central South University, Changsha, Hunan, China"
      ],
      "name": "Man-Jie Guo"
    },
    {
      "affiliations": [
        "Xiangya School of Nursing, Central South University, Changsha, Hunan, China"
      ],
      "name": "Ruo-Ling Yu"
    },
    {
      "affiliations": [
        "Health Management Medicine Center and Nursing Department, Third Xiangya Hospital of Central South University, Changsha, Hunan, China"
      ],
      "name": "Xue-Lian Liu"
    },
    {
      "affiliations": [
        "Health Management Medicine Center and Nursing Department, Third Xiangya Hospital of Central South University, Changsha, Hunan, China"
      ],
      "name": "Ting Peng"
    },
    {
      "affiliations": [
        "Department of Dermatology, Xiangya Hospital of Central South University, Changsha, Hunan, China"
      ],
      "name": "Xuan Yang"
    },
    {
      "affiliations": [
        "Health Management Medicine Center and Nursing Department, Third Xiangya Hospital of Central South University, Changsha, Hunan, China"
      ],
      "name": "Chun-Xiang Qin"
    }
  ],
  "title": "Comparison of the identification and practicability of non-invasive diagnostic indicators under NAFLD, MAFLD and MASLD in China: a cross-sectional study",
  "uid": "1fe2eb2d-3673-5957-8594-613d41e06f69"
}