ArticlePloS one2019
The ZJU index is a powerful surrogate marker for NAFLD in severely obese North American women.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00712127 (Preventing Adverse Effects In Class II and Class III Obesity), which is not on this map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Preventing Adverse Effects In Class II and Class III Obesity
Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Diagnostic accuracy of the visceral adiposity index in patients with metabolic-associated fatty liver disease: a meta-analysis.Lipids in health and disease · 2022Pooled it
- ZJU index and the prevalence of kidney stones in US adults: evidence from NHANES 2007-2018.BMC urology · 2026Article
- Surveying the features of screening strategies for non-alcoholic fatty liver disease: A scoping review.Journal of education and health promotion · 2026Review
- Ethnic-specific ZJU index thresholds for hepatic steatosis and fibrosis in Chinese MASLD.Frontiers in medicine · 2026Article
- Exploring the association between the ZJU index and overactive bladder: a cross-sectional study based on NHANES 2011-2018.Translational andrology and urology · 2025Article
- From fatty liver indices to the Zhejiang University index: Re-shaping risk stratification of metabolic liver disease in diabetes.World journal of diabetes · 2025Article
- Association between Zhejiang University index and metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus.World journal of diabetes · 2025Article
- Novel Insights into the Association of ZJU index with Periodontitis in US participants: a cross-sectional study.Lipids in health and disease · 2025Article
- Analysis of the efficacy of the ZJU index and triglyceride‒glucose product index in identifying obstructive sleep apnea hypoventilation syndrome in patients with metabolic syndrome.Hormones (Athens, Greece) · 2025Article
- Study of association and diagnostic utility of novel anthropometric and lipid indices for nonalcoholic fatty liver disease: A hospital-based study.Journal of family medicine and primary care · 2025Article
- Association Between Visceral Adiposity and the Prediction of Hepatic Steatosis and Fibrosis in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).Journal of clinical medicine · 2025Article
- Relationship Between the ZJU Index and Infertility Risk in Reproductive-Aged US Women: An Analysis of NHANES 2013-2018.International journal of women's health · 2025Article
- Assessment of the diagnostic efficacy of five non-invasive tests for MASLD: external validation utilizing data from two cohorts.Frontiers in nutrition · 2025Article
- Association between ZJU index and gallstones in US adult: a cross-sectional study of NHANES 2017-2020.BMC gastroenterology · 2024Article
- The ZJU index is associated with the risk of sarcopenia in American adults aged 20-59: a cross-sectional study.Lipids in health and disease · 2024Article
- Correlation between ZJU index and hepatic steatosis and liver fibrosis in American adults with NAFLD.Frontiers in medicine · 2024Article
- Association between the ZJU index and risk of new-onset non-alcoholic fatty liver disease in non-obese participants: a Chinese longitudinal prospective cohort study.Frontiers in endocrinology · 2024Article
- ZJU Index as a Predictive Tool for Diabetes Incidence: Insights from a Population-Based Cohort Study.Diabetes, metabolic syndrome and obesity : targets and therapy · 2024Article
- The ZJU index is associated with the risk of obstructive sleep apnea syndrome in Chinese middle-aged and older people: a cross-sectional study.Lipids in health and disease · 2023Article
- Liver Fat Scores for Noninvasive Diagnosis and Monitoring of Nonalcoholic Fatty Liver Disease in Epidemiological and Clinical Studies.Journal of clinical and translational hepatology · 2023Review
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
introductionNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the western world and is highly associated with multiple cardiometabolic complications. The Zhejiang University (ZJU) index was first developed to predict NAFLD in Chinese populations, where it was shown to have better predictive value than other currently used indices. The aims of the present study were to 1) determine the diagnostic accuracy of ZJU index in identifying NAFLD in a well-phenotyped cohort of obese middle-aged American women and 2) compare its performance with other non-invasive indices for NAFLD identification.
methodsTo achieve this goal, we performed a retrospective analysis of a prospectively-collected cohort of participants enrolled in a weight loss trial for severe obesity (RENEW, clinicaltrials.gov identifier: NCT00712127). One hundred and seven women between the age of 30 and 55 with obesity class II (BMI 35-39.9 kg/m2) or class III (BMI ≥ 40 kg/m2) were recruited for analyses. Hepatic steatosis was measured using liver/spleen attenuation ratio (L/S ratio) from unenhanced abdominal computed tomography. Beside ZJU index, hepatic steatosis index (HSI), lipid accumulation production index (LAPI), and visceral adiposity index (VAI) were also determined and to compare their performance in predicting NAFLD.
resultsOf 107 obese women in the study, 40 (37.4%) met imaging criteria for NAFLD using cut-off value of L/S ratio < 1.1. The ZJU index was positively correlated with HIS, LAPI, but not VAI. The area under the curve was highest for the ZJU index (AUC = 0.742, 95% CI:0.647-0.837), followed by HSI (AUC = 0.728, 95% CI:0.631-0.825), LAPI (AUC = 0.682, CI:0.583-0.781), and VAI (AUC = 0.621, 95% CI:0.518-0.725), respectively, using the Youden method.
conclusionThe ZJU index is a powerful surrogate marker for NAFLD in severely obese western females and its predictive value was better than that of other commonly used indices for predicting NAFLD. Our study is the first to suggest that the ZJU index could be a promising model for use in western as well as Chinese populations.
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