Background: Non-invasive tests (NITs) are necessary for knowing the true prevalence of fatty liver (FL) and advanced fibrosis (AF). Noninvasive tests (NITs) for diagnosis of FL and fibrosis were compared. Methods: Data were obtained from the National Health and Examination Survey (NHANES; 2017-2018). Participants were excluded with other liver diseases, missing data for NIT calculation and/or excessive alcohol use. Area under the receiver operating characteristic (AUROC) compared the accuracy of 4 FL NITs (CAP, HIS, FLI, USFLI) among themselves and to CAP value of 285 dB/m and 5 fibrosis NITs (transient elastography, APRI, NFS, FIB-4, HEPAmet) among themselves and to LSM ≥ 8.7 kPa. Results: Among 2051 participants (average age 47 (±17.7), 48% males, 62% white, 73% overweight/obese, 39% metabolic syndrome), demographics were similar among NIT groups (CAP=812; HSI=1,234; FLI=935; USFLI-824). FL prevalence by NIT: 39% CAP, 58% HSI, 47% FLI, 37% USFLI. AF prevalence by test- LSM (≥ 8.7 kPa) 10%-14%; FIB-4 (≥2.67) and APRI (≥0.7) 1.3%- 2.7%; HEPAmet (>0.47) 14%-21%. Compared to CAP ≥285, FLI (AUROC= 0.823) and USFLI (AUROC=0.833) performed better than HSI (AUROC: 0.798). Compared to LSM ≥8.7kPa, only NFS (AUROC= 0.722) performed well (Fib-4 AUROC=0.606; APRI=0.647; HEPAmet=0.629). Among the CAP cohort, the strongest FL predictor was obesity (OR 15.2, 95%CI 7.97-28.9, P35%. NITs for FL performed well but not for AF. CAP and LSM as a second NIT reduced those considered indeterminate.

The Author(s). Published by S. Karger AG, Basel