{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:02:43Z","timestamp":1792443763571,"version":"4.5.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"IMPORTANCE<\/jats:title>The diagnostic performance of the fibrosis-4 index (FIB-4) and nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) for advanced fibrosis in lean patients with NAFLD is limited.<\/jats:p><\/jats:sec>OBJECTIVE<\/jats:title>To evaluate the diagnostic performance of the FIB-4 and NFS in lean individuals with NAFLD.<\/jats:p><\/jats:sec>DESIGN, SETTING, AND PARTICIPANTS<\/jats:title>This diagnostic study included adults with biopsy-proven NAFLD from 6 referral centers in Asia from 1995 to 2019. Cohorts were matched by age and sex between the lean and nonlean groups. All statistical analyses were executed from October 2022 to March 2023.<\/jats:p><\/jats:sec>MAIN OUTCOMES AND MEASURES<\/jats:title>The diagnostic performance of the FIB-4 and NFS at the current cutoff for advanced hepatic fibrosis in lean (body mass index [BMI] below 23 [calculated as weight in kilograms divided by height in meters squared]) and nonlean (BMI above 23) patients were evaluated.<\/jats:p><\/jats:sec>RESULTS<\/jats:title>A total of 1501 patients were included in analysis (mean [SD] age, 46.1 [16.4] years); 788 male (52.5%), 115 lean (7.7%), 472 (30.2%) Korean, 821 (48.7%) Japanese, and 341 (21.3%) Taiwanese. Among the age- and sex-matched cohort, the mean (SD) age was 52.3 (15.1) years and 41.2% (47 of 114) were male. The diagnostic performance and areas under the operating characteristic curve of the FIB-4 (lean, 0.807 vs nonlean, 0.743; P<\/jats:italic>\u2009=\u2009.28) and NFS (lean, 0.790 vs nonlean, 0.755; P<\/jats:italic>\u2009=\u2009.54) between the 2 groups were comparable in the age- and sex-matched cohort. The sensitivity and specificity of the NFS showed increasing and decreasing tendency according to the BMI quartiles (P<\/jats:italic> for trend\u2009&amp;lt;\u2009.001), while those of the FIB-4 did not (P<\/jats:italic> for trend\u2009=\u2009.05 and P<\/jats:italic>\u2009=\u2009.20, respectively). Additionally, although the areas under the operating characteristic curve of the FIB-4 and NFS were not significantly different in the lean group (0.807 vs 0.790; P<\/jats:italic>\u2009=\u2009.09), the sensitivity of the current NFS cutoff values was lower in the lean group than in that of FIB-4 (54.4% vs 81.8%; P<\/jats:italic>\u2009=\u2009.03).<\/jats:p><\/jats:sec>CONCLUSIONS AND RELEVANCE<\/jats:title>In this cohort study, the performance of the FIB-4 and NFS in diagnosing advanced fibrosis did not differ significantly between the 2 groups overall. However, in lean NAFLD, while the sensitivity for diagnosing advanced hepatic fibrosis remained reasonable at the current cutoff level, the sensitivity of NFS at the current cutoff was too low to be an adequate screening tool.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.29568","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T15:13:33Z","timestamp":1692285213000},"page":"e2329568","source":"Crossref","is-referenced-by-count":33,"title":["Diagnostic Performance of the Fibrosis-4 Index and Nonalcoholic Fatty Liver Disease Fibrosis Score in Lean Adults With Nonalcoholic Fatty Liver Disease"],"prefix":"10.1001","volume":"6","author":[{"given":"Huiyul","family":"Park","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Myoungji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen 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Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonghyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye-Lin","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Sahmyook University, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeang","family":"Arai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Atsukawa","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miwa","family":"Kawanaka","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Toyoda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatoshi","family":"Ishigami","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Lung","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Won","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea"},{"name":"Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea"},{"name":"Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science and Engineering, Seoul, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindie H.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, California"},{"name":"Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, 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