Xiaomeng Ling Zhuyan Xu Juan Li Xiaomin Ma Jing Ji Xue Jia Baozhen Wang ^* Min Zhao ^*

• Shandong University, Jinan, Shandong Province, China

The aim of this study is to evaluate the efficacy of non-invasive indicators for the screening of non-alcoholic fatty liver disease (NAFLD) in adolescents.: The presence of liver steatosis was assessed by Transient Elastography (TE) in adolescents from National Health and Nutrition Examination Survey (NHANES) 2017-2018. The diagnostic accuracy of three simple indicators including body mass index (BMI) combined with alanine aminotransferase (ALT), hepatic steatosis index (HSI) and fatty liver index (FLI) was assessed using controlled attenuation parameter (CAP) as gold standard. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve (AUC) for each indicator. The optimal cut-off values were determined by Youden index.Results: Among the 724 adolescents included in the study, 198(27.3%) subjects with CAP≥248 were diagnosed with NAFLD. The NAFLD group possessed significant difference in obesity-related variables compared to non-NAFLD group.HSI and FLI showed better diagnostic accuracy (AUC of HSI: 0.8870 for males, 0.8047 for females; AUC of FLI: 0.8806 for males, 0.7963 for females) compared to the combination of obesity and elevated ALT (0.8673 for males, 0.7592 for females). The optimal cut-off values of HSI and FLI were obtained (HSI: 31.0 for males, 34.0 for females; FLI: 17.1 for males, 22.3 for females). The performance of all three indicators showed significant differences between the sexes.The performance of HSI and FLI was shown to be acceptable and provides a practical method for the primary screening test. However, due to the differences observed between the sexes, caution should be exercised when using these indicators.