Letters to the editor
Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures
Department of Infectious Diseases, Yiwu Central Hospital, Zhejiang 322000, China
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Ibarra-Reynoso" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Monica C." "apellidos" => "Preciado-Puga" ] 1 => array:2 [ "nombre" => "Yeniley" "apellidos" => "Ruiz-Noa" ] 2 => array:2 [ "nombre" => "Juana R." "apellidos" => "Garcia-Ramirez" ] 3 => array:2 [ "nombre" => "Benjamin" "apellidos" => "Jordan-Perez" ] 4 => array:2 [ "nombre" => "Serafin" "apellidos" => "Garnelo-Cabañas" ] 5 => array:2 [ "nombre" => "Maria L." "apellidos" => "Lazo de la Vega-Monroy" ] 6 => array:2 [ "nombre" => "Karen I." "apellidos" => "Gutierrez-Aguirre" ] 7 => array:2 [ "nombre" => "Lorena R." 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Ibarra-Reynoso" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Monica C." "apellidos" => "Preciado-Puga" ] 1 => array:2 [ "nombre" => "Yeniley" "apellidos" => "Ruiz-Noa" ] 2 => array:2 [ "nombre" => "Juana R." "apellidos" => "Garcia-Ramirez" ] 3 => array:2 [ "nombre" => "Benjamin" "apellidos" => "Jordan-Perez" ] 4 => array:2 [ "nombre" => "Serafin" "apellidos" => "Garnelo-Cabañas" ] 5 => array:2 [ "nombre" => "Maria L." "apellidos" => "Lazo de la Vega-Monroy" ] 6 => array:2 [ "nombre" => "Karen I." "apellidos" => "Gutierrez-Aguirre" ] 7 => array:2 [ "nombre" => "Lorena R." "apellidos" => "Ibarra-Reynoso" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S166526812100034X?idApp=UINPBA00004N" "url" => "/16652681/000000220000000C/v3_202107300613/S166526812100034X/v3_202107300613/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letters to the editor</span>" "titulo" => "Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lingzhen Jin, Xiaofei Li" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Lingzhen" "apellidos" => "Jin" ] 1 => array:4 [ "nombre" => "Xiaofei" "apellidos" => "Li" "email" => array:1 [ 0 => "icqwc46@163.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Infectious Diseases, Yiwu Central Hospital, Zhejiang 322000, China" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Puga et al. recently published an intriguing study entitled “<span class="elsevierStyleBold">Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures</span>” in Annals of Hepatology [<a class="elsevierStyleCrossRef" href="#bib0005">1</a>]. The results of this cross-sectional study provided evidence for the clinical diagnosis of Non-Alcoholic Fatty Liver Disease (NAFLD). Although we fully agree with the conclusions of this study, the association between body mass index (BMI) and NAFLD needs to be highlighted.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Defined as weight (kg)/height (m)<span class="elsevierStyleSup">2</span>, BMI [<a class="elsevierStyleCrossRef" href="#bib0010">2</a>,<a class="elsevierStyleCrossRef" href="#bib0015">3</a>] is a crucial marker widely adopted in clinical practice to judge obesity (BMI ≥ 30 kg/m<span class="elsevierStyleSup">2</span>) [<a class="elsevierStyleCrossRef" href="#bib0020">4</a>]. Further, considering that the indicators (weight and height) for calculating BMI can be easily obtained from medical record systems, BMI is extensively applied in clinical decision-making, including NAFLD. A cohort study based on community population found that BMI is a significant factor in predicting the occurrence of NAFLD, implying that clinicians could use BMI to judge the probability of NAFLD occurrence [<a class="elsevierStyleCrossRef" href="#bib0025">5</a>]. Further evidence from Australia has similarly suggested that obese people have a higher incidence of NAFLD [<a class="elsevierStyleCrossRef" href="#bib0030">6</a>]. The above evidence indicates that BMI or obesity is closely related to the occurrence of NAFLD. As detailed in <span class="elsevierStyleBold">Table 1</span> of the study of Puga et al. [<a class="elsevierStyleCrossRef" href="#bib0005">1</a>], patients with NAFLD have significantly higher BMI levels than those without NAFLD (30.96 ± 4.71 versus 27.81 ± 5.26, P = 0.025). Hence, BMI could be a vital confounding factor in exploring whether clinical indices and hepatic ultrasound measurements can improve the diagnostic accuracy of NAFLD. In our opinion, performing subgroup analysis premised on the BMI value or conducting regression analysis to adjust BMI might help to obtain reliable conclusions.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Declaration of funding interests</span><p id="par0015" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Declaration of funding interests" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-04" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-invasive diagnosis of non-alcoholic fatty liver disease using an algorithm combining clinical indexes and ultrasonographic measures" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Preciado-Puga" 1 => "Y. Ruiz-Noa" 2 => "J.R. Garcia-Ramirez" 3 => "B. Jordan-Perez" 4 => "S. Garnelo-Cabañas" 5 => "M.L. Lazo de la Vega-Monroy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aohep.2020.09.008" "Revista" => array:2 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2020" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Bann" 1 => "W. Johnson" 2 => "L. Li" 3 => "D. Kuh" 4 => "R. 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