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Hepatic steatosis, defined as increased hepatocellular lipid content HCL, associates with visceral obesity and glucose intolerance. As exact HCL quantification by 1H-magnetic resonance spectroscopy 1H-MRS is not generally available, various clinical indices are increasingly used to predict steatosis.


The purpose of this study was to test the accuracy of NAFLD liver fat score NAFLD-LFS, hepatic steatosis index HSI and fatty liver index FLI against 1H-MRS and their relationships with insulin sensitivity and secretion.

Design, Setting and Participants

Ninety-two non-diabetic, predominantly non-obese humans underwent clinical examination, 1H-MRS and an oral glucose tolerance test OGTT to calculate insulin sensitivity and β-cell function. Accuracy of indices was assessed from the area under the receiver operating characteristic curve AROC.


Median HCL was 2.49% 0.62;4.23 and correlated with parameters of glycemia across all subjects. NAFLD-LFS, FLI and HSI yielded AROCs of 0.70, 0.72, and 0.79, respectively, and related positively to HCL, insulin resistance, fasting and post-load β-cell function normalized for insulin resistance. Upon adjustment for age, sex and HCL, regression analysis revealed that NAFLD-LFS, FLI and HSI still independently associated with both insulin sensitivity and β-cell function.


The tested indices offer modest efficacy to detect steatosis and cannot substitute for fat quantification by 1H-MRS. However, all indices might serve as surrogate parameters for liver fat content and also as rough clinical estimates of abnormal insulin sensitivity and secretion. Further validation in larger collectives such as epidemiological studies is needed.

Autor: Sabine Kahl, Klaus Straßburger, Bettina Nowotny, Roshan Livingstone, Birgit Klüppelholz, Kathrin Keßel, Jong-Hee Hwang, Guido



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