The HAALT Non-invasive Scoring System for NAFLD in Obesity

  • Harsh ShethEmail author
  • Samir Bagasrawala
  • Mita Shah
  • Rais Ansari
  • A. Olithselvan
  • Muffazal Lakdawala
Original Contributions



The prevalence of NAFLD increases in obese diabetics. Accurate diagnosis of NAFLD requires invasive liver biopsies, which is costly, and time consuming and labor intensive. Currently, there is a lack of non-invasive diagnostic methods to identify those with NASH, in obese Indians.


To develop an accurate non-invasive scoring system using clinical and biochemical parameters to predict the risk of developing non-alcoholic steatohepatitis (NASH).


Clinical and biochemical parameters were recorded pre-operatively from 290 patients who were posted for bariatric/metabolic surgery, between September 2017 and October 2018 and compared with the result of intra-operative liver biopsy NAFLD activity scores (NAS).


The mean weight and BMI of the patients were 120.3 ± 24.6 and 45.5 ± 7.8 respectively. In the final histopathological examination, 196/290 (67.6%) had simple steatosis, 92/290 (31.7%) had NASH, and 2/290 (0.007%) had cirrhosis. Binary logistic regression analysis of multiple independent predictors yielded five independent factors that were statistically significant (HbA1c, AST, ALT, liver span on USG, and serum triglycerides). These were used to create a scoring system, with a range of scores from 0 to 6, with maximum predictability at a score of 6. Patients with scores of ≧ 3 were at high risk of NASH diagnosis. The sensitivity of this scoring system was 85.87% and diagnostic accuracy was 75.35%.


Our study not only confirms the significant association of NAFLD with obesity but also outlines a simple non-invasive scoring system to identify obese individuals at high risk for NASH.


Obesity Metabolic syndrome Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Liver biopsy Type 2 diabetes mellitus Bariatric surgery Scoring system Predictive model Hepatosteatosis Morbid obesity 



We would like to thank Dr. V. P Desa, Medical Director, Dr. Iqbal Bagasrawala, Associate Medical Director, and Dr. Shabina Shaikh, Senior Manager, Medical Administration, Saifee Hospital for providing us with the platform to conduct this study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Minimally Invasive Surgical Sciences and ResearchSaifee HospitalMumbaiIndia
  2. 2.Department of PathologySaifee HospitalMumbaiIndia
  3. 3.Department of HepatologyYashoda HospitalSecunderabadIndia

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