From fatty liver indices to the Zhejiang University index - Re-shaping risk stratification of metabolic liver disease in diabetes

Sep 28, 2026

This editorial discusses a study by Tao et al, focusing on a scalable diagnostic tool for metabolic dysfunction-associated steatotic liver disease (MASLD) in type 2 diabetes mellitus (T2DM). It reviews classical indices such as fatty liver index (FLI), hepatic steatosis index (HSI), and non-alcoholic fatty liver disease-liver fat score, noting variable predictive accuracy across populations. It highlights that the China-developed Zhejiang University index (ZJU index) integrates fasting glucose, triglycerides, hepatic enzyme ratios, and BMI, showing stronger performance in Chinese T2DM.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Editorial

Core Tip

Introduction

| W | J | D | World Journal of
Diabetes | | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Diabetes 2025 December 15; 16(12): 115435 DOI: 10.4239/wjd.v16.i12.115435 ISSN 1948-9358 (online) EDITORIAL From fatty liver indices to the Zhejiang University index: Re-shaping risk stratification of metabolic liver disease in diabetes Mostafa M Gouda Specialty type: Endocrinology and metabolism Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade C Novelty: Grade C Creativity or Innovation: Grade C Scientific Significance: Grade C P-Reviewer: Wei JP, MD, China Received: October 16, 2025 Revised: November 8, 2025 Accepted: November 18, 2025 Published online: December 15, 2025 Processing time: 60 Days and 3.6 Hours Mostafa M Gouda, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310027, Zhejiang Province, China Mostafa M Gouda, Department of Nutrition and Food Science, National Research Centre, Giza 12622, Egypt Corresponding author: Mostafa M Gouda, PhD, Professor, College of Biosystems Engineering and Food Science, Zhejiang University, No. 866 Yuhangtang Road, Hangzhou 310027, Zhejiang Province, [China.](China. mostafa-gouda@zju.edu.cn)[ mostafa-gouda@zju.edu.cn](China. mostafa-gouda@zju.edu.cn) Abstract This editorial comments on the study by Tao et al, emphasizing the scalable diagnostic tool for metabolic dysfunction-associated steatotic liver disease (MASLD) in type 2 diabetes mellitus (T2DM) . Classical indices such as the fatty liver index (FLI), hepatic steatosis index (HSI), and non-alcoholic fatty liver disease-liver fat score have provided valuable insights. Still, their predictive accuracy often varies across populations and clinical settings. In Western cohorts, FLI and HSI are widely applied, yet they depend heavily on anthropometric or categorical variables, which limits their sensitivity in Asian populations. The Zhejiang University index (ZJU index), developed in China, integrates fasting glucose, triglycerides, hepatic enzyme ratios, and body mass index into a composite score of insulin resistance. Recent studies show that the ZJU index outperforms FLI and HSI in predicting MASLD among Chinese patients, particularly those with T2DM, where it demonstrates a nonlinear association with disease risk and identifies a critical threshold of 38.87. The ZJU index links to conditions like sarcopenia, sleep apnea, and gallstones, showing its versatility in metabolic health. This editorial comparesits performance with other indices and emphasizes the ZJU index as a nextgeneration tool for MASLD risk stratification globally. Key Words: Metabolic dysfunction-associated; Type 2 diabetes mellitus; Zhejiang University index; Fatty liver index; Hepatic steatosis index; Non-invasive diagnostics; Risk stratification ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. WJD [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 15, 2025 Volume 16 Issue 12 Gouda MM. Re-shaping risk stratification in metabolic liver disease Core Tip: Early identification of metabolic dysfunction-associated steatotic liver disease (MASLD) in diabetes requires reliable and easily applicable tools. The Zhejiang University index (ZJU index) combines metabolic and hepatic parameters, such as body mass index, fasting glucose, triglycerides, and enzyme ratios, into a simple score derived from routine clinical data. Unlike traditional indices such as fatty liver index and hepatic steatosis index, the ZJU index demonstrates superior accuracy for detecting MASLD and correlates with systemic complications, including insulin resistance and sarcopenia. Its integration into electronic medical records enables automatic annual screening of patients with type 2 di

FAQs

What are the classical indices compared with the ZJU index in this editorial?

The editorial compares the Zhejiang University index with fatty liver index (FLI), hepatic steatosis index (HSI), and non-alcoholic fatty liver disease-liver fat score.

Why might classical fatty liver indices perform differently in Asian populations?

Their predictive accuracy often varies because they rely heavily on anthropometric or categorical variables, which can limit sensitivity across populations and clinical settings.

What is the main purpose of the ZJU index in MASLD risk assessment for diabetes?

It provides a composite score using routine metabolic and hepatic parameters to improve detection of MASLD and support global risk stratification, including guiding timely preventive interventions.

Sep 28, 2026

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