{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:31:41Z","timestamp":1790775101284,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background and Aims: Screening for liver fibrosis presents a clinical challenge. This study aimed to explore a useful alternative method for assessing fibrosis risk among US adults at risk of metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: A liver stiffness score (LSS) model was proposed and tested using data from 3976 participants at possible risk of MASLD, obtained from the US National Health and Nutrition Examination Survey (NHANES). Results: The LSS model was developed using liver stiffness measurements, blood biochemistry, and body measurement data from 2414 NHANES participants at risk of MASLD, sampled between 2017 and 2020: LSS = exp(0.007035 \u00d7 bodyweightkg \u2212 0.1061 \u00d7 raceblack1,0 + 0.183221 \u00d7 diabetes1,0 + 0.008539 \u00d7 ASTIU\/L \u2212 0.0018 \u00d7 plateletcount1000cell\/UL \u2212 0.21011 \u00d7 albuming\/dL + 2.259087). The probability (P) of having fibrosis F3 + F4 is calculated as follows: P = 0.0091 \u00d7 LSS2 \u2212 0.0791 \u00d7 LSS + 0.1933. The developed LSS model was tested on 1562 at-risk participants from the 2017\u20132018 cycle. The results showed that the LSS model achieved AUROC values of 0.79 and 0.78 for diagnosing cirrhosis (F4) and advanced fibrosis (F3 + F4) in the US population, respectively. It outperformed existing models such as NFS, FIB-4, SAFE, and FIB-3. For screening F3 + F4 fibrosis, the LSS model\u2019s top decile outperformed the NFS and FIB-4 models by 37.7% and 42.6%, respectively. Additionally, it showed superior performance compared to the waist circumference classification method by 29.5%. Conclusions: derived from an ethnically diverse population dataset, the LSS screening model, along with its probability equation, may offer clinicians a valuable alternative method for assessing the risk of liver fibrosis in the at-risk adult population.<\/jats:p>","DOI":"10.3390\/diseases12070150","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T11:33:22Z","timestamp":1720697602000},"page":"150","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An Alternative Non-Invasive Screening Model for Liver Fibrosis among US Adults at Risk of MASLD"],"prefix":"10.3390","volume":"12","author":[{"given":"Hongbing","family":"Sun","sequence":"first","affiliation":[{"name":"Nutrition, Biostatistics and Health Study, Department of Earth and Chemical Sciences, Rider University, 2083 Lawrenceville Road, Lawrenceville, NJ 08648, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Canivet, C.M., and Boursier, J. (2022). Screening for Liver Fibrosis in the General Population: Where Do We Stand in 2022?. Diagnostics, 13.","DOI":"10.3390\/diagnostics13010091"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1136\/gutjnl-2017-314924","article-title":"Guidelines on the management of abnormal liver blood tests","volume":"67","author":"Newsome","year":"2018","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1056\/NEJMoa2029349","article-title":"Prospective study of outcomes in adults with nonalcoholic fatty liver disease","volume":"385","author":"Sanyal","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1136\/gutjnl-2020-321299","article-title":"Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology","volume":"69","author":"Neuberger","year":"2020","journal-title":"Gut"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"475","DOI":"10.3748\/wjg.v20.i2.475","article-title":"Limitations of liver biopsy and non-invasive diagnostic tests for the diagnosis of nonalcoholic fatty liver disease\/nonalcoholic steatohepatitis","volume":"20","author":"Sumida","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1155\/2014\/952684","article-title":"The feasibility and reliability of transient elastography using Fibroscan: A practice audit of 2335 examinations","volume":"28","author":"Pang","year":"2014","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/hep.21669","article-title":"FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and Fibrotest","volume":"46","author":"Mallet","year":"2007","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/liv.14669","article-title":"Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events: A systematic review","volume":"41","author":"Lee","year":"2021","journal-title":"Liver Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1016\/j.cgh.2018.12.031","article-title":"Diagnostic accuracy of noninvasive fibrosis models to detect change in fibrosis stage","volume":"17","author":"Siddiqui","year":"2019","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a Simple Noninvasive Index to Predict Significant Fibrosis in Patients with HIV\/HCV Coinfection","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1002\/hep.21496","article-title":"The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD","volume":"45","author":"Angulo","year":"2007","journal-title":"Hepatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/j.cgh.2024.02.008","article-title":"Degree of Discordance Between FIB-4 and Transient Elastography: An Application of Current Guidelines on General Population Cohort","volume":"22","author":"Chang","year":"2024","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1016\/j.cgh.2021.12.034","article-title":"Low accuracy of FIB-4 and NAFLD fibrosis scores for screening for liver fibrosis in the population","volume":"20","author":"Graupera","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Vigan\u00f2, M., Pugliese, N., Cerini, F., Turati, F., Cimino, V., Ridolfo, S., Rocchetto, S., Foglio, F., Terrin, M., and La Vecchia, C. (2022). Accuracy of FIB-4 to detect elevated liver stiffness measurements in patients with nonalcoholic fatty liver disease: A cross-sectional study in referral centers. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232012489"},{"key":"ref_15","unstructured":"US CDC, and National Center for Health Statistics (2024, June 04). National Health and Nutrition Examination Survey (NHANES) Comprehensive Data List, Available online: https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/search\/datapage.aspx?Component."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1053\/j.gastro.2021.07.049","article-title":"Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease","volume":"161","author":"Kanwal","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1097\/HEP.0000000000000323","article-title":"AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease","volume":"77","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1002\/hep.25993","article-title":"Determination of reliability criteria for liver stiffness evaluation by transient elastography","volume":"57","author":"Boursier","year":"2013","journal-title":"Hepatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1111\/liv.15538","article-title":"Liver stiffness is associated with excess mortality in the general population driven by heart failure: The Rotterdam Study","volume":"43","author":"Sonneveld","year":"2023","journal-title":"Liver Int."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Orr, C.J., Keyserling, T.C., Ammerman, A.S., and Berkowitz, S.A. (2019). Diet quality trends among adults with diabetes by socioeconomic status in the US: 1999\u20132014. BMC Endocr. Disord., 19.","DOI":"10.1186\/s12902-019-0382-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3093","DOI":"10.2337\/dc13-0570","article-title":"Food insecurity and metabolic control among US adults with diabetes","volume":"36","author":"Berkowitz","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Sun, H., and Weaver, C.M. (2023). Trends in Diet Quality and Increasing Inadequacies of Micronutrients Vitamin C, Vitamin B12, Iron and Potassium in US Type 2 Diabetic Adults. Nutrients, 15.","DOI":"10.3390\/nu15081980"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s11894-014-0372-6","article-title":"Utilization of FibroScan in clinical practice","volume":"16","author":"Bonder","year":"2014","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.cgh.2018.11.011","article-title":"FibroScan identifies patients with nonalcoholic fatty liver disease and cardiovascular damage","volume":"18","author":"Lombardi","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1002\/hep.32545","article-title":"The steatosis-associated fibrosis estimator (SAFE) score: A tool to detect low-risk NAFLD in primary care","volume":"77","author":"Sripongpun","year":"2023","journal-title":"Hepatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1016\/j.gastha.2022.07.012","article-title":"Fibrosis-3 index: A new score to predict liver fibrosis in patients with nonalcoholic fatty liver disease without age as a factor","volume":"1","author":"Kariyama","year":"2022","journal-title":"Gastro Hep Adv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3762651","DOI":"10.1155\/2017\/3762651","article-title":"Defining an optimal cut-point value in ROC analysis: An alternative approach","volume":"2017","author":"Unal","year":"2017","journal-title":"Comput. Math. Methods Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1002\/hep.25762","article-title":"The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association","volume":"55","author":"Chalasani","year":"2012","journal-title":"Hepatology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.jhep.2010.04.008","article-title":"A position statement on NAFLD\/NASH based on the EASL 2009 special conference","volume":"53","author":"Ratziu","year":"2010","journal-title":"J. Hepatol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/7\/150\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:15:11Z","timestamp":1760109311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/12\/7\/150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,11]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["diseases12070150"],"URL":"https:\/\/doi.org\/10.3390\/diseases12070150","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,11]]}}}