NAFLD in clinical practice: can simple blood and anthropometric markers be used to detect change in liver fat measured by 1H-MRS?

Background & Aims: Research in NAFLD management is commonly based on quantitative assessment of liver fat by proton-magnetic resonance spectroscopy (H-MRS), and translation of this into clinical practice is currently limited by availability and expense. Novel steatosis biomarkers have been proposed for the prediction of liver fatness; however, whether these are suitable for detecting changes in liver fat is unknown. We aimed to determine the accuracy of these indices, and waist circumference (WC), in quantifying longitudinal change in H-MRS-quantified liver fat. Methods: We performed a secondary analysis using data from 97 overweight/obese adults (age: 39.7±11.5\ua0years, body mass index: 30.7±4.4\ua0kg/m, liver fat: 6.0±4.8%, 65% male) who completed either an 8-week exercise or 12-week nutraceutical intervention, with varying degrees of change in liver fat. Baseline and post-intervention measures were liver fat (H-MRS), NAFLD Liver Fat Score, Liver Fat Equation (LFE), Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), the Visceral Adiposity Index (VAI) and WC. Results: Only the change in HSI, FLI and WC was associated with change in liver fat; however, correlations were weak to moderate. There was no agreement between the LFE and H-MRS for detecting liver fat change. Only change in WC significantly affected change in liver fat (