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Comparative diagnostic value of novel and traditional anthropometric indices in FibroScan-diagnosed NAFLD among Turkish adults

Yıl 2025, Cilt: 6 Sayı: 2, 78 - 84, 23.03.2025
https://doi.org/10.47582/jompac.1626490

Öz

Aims: Nonalcoholic fatty liver disease (NAFLD) is a growing global health concern associated with chronic liver damage and metabolic comorbidities. Traditional anthropometric measures—such as body-mass index (BMI) and waist circumference (WC), have known limitations. This study aimed to compare the diagnostic performance of novel obesity indices, including a body shape index (ABSI) and body roundness index (BRI), with conventional parameters in predicting NAFLD.
Methods: A retrospective study was conducted with 430 Turkish adults (aged 18–74) undergoing FibroScan assessments. Anthropometric data (body weight, height, WC) and controlled attenuation parameter (CAP) values were collected. NAFLD was defined as CAP ≥257 dB/m. Predictive capabilities of BMI, WC, ABSI, BRI, waist-to-height ratio (WHtR), and body weight were compared using receiver operating characteristic (ROC) curve analyses. Pairwise area under-the-curve (AUC) comparisons were performed using the DeLong test, with significance set at p<0.05.
Results: Body weight displayed the highest area under the ROC curve (AUC) for NAFLD diagnosis (AUC=0.766; 95% CI: 0.716 0.816). BMI (AUC=0.695; 95% CI: 0.637–0.753) and WC (AUC=0.693; 95% CI: 0.636–0.750) had comparable performance. BRI and WHtR demonstrated lower AUC values (AUC=0.621), while ABSI had insufficient discriminatory ability (AUC=0.485). NAFLD prevalence was significantly higher in males (71% vs. 50%, p<0.001), aligning with prior epidemiological reports.
Conclusion: Among Turkish patients diagnosed via FibroScan, body weight emerged as the strongest predictor of NAFLD, with BMI and WC remaining reliable alternatives. Novel indices such as BRI and ABSI showed limited utility for clinical diagnosis. These findings highlight the continued relevance of simple and traditional measurements for identifying NAFLD risk.

Etik Beyan

Bursa Şehir Hastanesi Bilimsel Araştırmalar Etik Kurulu Karar Formu: Karar no: 2025-2/15

Kaynakça

  • Sanyal AJ, Brunt EM, Kleiner DE, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54(1):344-353. doi:10.1002/hep.24376
  • Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American association for the study of liver diseases. Hepatology. 2018;67(1):328-357. doi:10.1002/hep.29367
  • European association for the study of the liver (EASL); European association for the study of diabetes (EASD); European association for the study of obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi:10. 1016/j.jhep.2024.04.031
  • Calzadilla Bertot L, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci. 2016;17(5):774. doi:10.3390/ijms17050774
  • Ekstedt M, Nasr P, Kechagias S. Natural history of NAFLD/NASH. Curr Hepatol Rep. 2017;16(4):391-397. doi:10.1007/s11901-017-0378-2
  • GBD 2019 diseases and injuries collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
  • Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(1):73-84. doi:10.1002/hep.28431
  • Farrell GC, Wong VW, Chitturi S. NAFLD in Asia--as common and important as in the West. Nat Rev Gastroenterol Hepatol. 2013;10(5):307-318. doi:10.1038/nrgastro.2013.34
  • Polyzos SA, Kountouras J, Mantzoros CS. Obesity and nonalcoholic fatty liver disease: from pathophysiology to therapeutics. Metabolism. 2019;92:82-97. doi:10.1016/j.metabol.2018.11.014
  • VanWagner LB, Khan SS, Ning H, et al. Body-mass index trajectories in young adulthood predict non-alcoholic fatty liver disease in middle age: the CARDIA cohort study. Liver Int. 2018;38(4):706-714. doi:10.1111/liv. 13603
  • Pang Q, Zhang JY, Song SD, et al. Central obesity and nonalcoholic fatty liver disease risk after adjusting for body-mass index. World J Gastroenterol. 2015;21(5):1650-1662. doi:10.3748/wjg.v21.i5.1650
  • Xing J, Guan X, Zhang Q, Chen S, Wu S, Sun X. Triglycerides mediate body-mass index and nonalcoholic fatty liver disease: a population-based study. Obes Facts. 2021;14(2):190-196. doi:10.1159/000514848
  • Church TS, Kuk JL, Ross R, Priest EL, Biltoft E, Blair SN. Association of cardiorespiratory fitness, body mass index, and waist circumference to nonalcoholic fatty liver disease. Gastroenterology. 2006;130(7):2023-2030. doi:10.1053/j.gastro.2006.03.019
  • Kim D, Chung GE, Kwak MS, et al. Body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2016;14(1):132-8.e4. doi:10.1016/j.cgh.2015.07.024
  • Moore JB. Non-alcoholic fatty liver disease: the hepatic consequence of obesity and the metabolic syndrome. Proc Nutr Soc. 2010;69(2):211-220. doi:10.1017/S0029665110000030
  • Blundell JE, Dulloo AG, Salvador J, Frühbeck G; EASO SAB Working Group on BMI. Beyond BMI--phenotyping the obesities. Obes Facts. 2014;7(5):322-328. doi:10.1159/000368783
  • Michels KB, Greenland S, Rosner BA. Does body-mass index adequately capture the relation of body composition and body size to health outcomes? Am J Epidemiol. 1998;147(2):167-172. doi:10.1093/oxfordjournals.aje.a009430
  • Fang H, Berg E, Cheng X, Shen W. How to best assess abdominal obesity. Curr Opin Clin Nutr Metab Care. 2018;21(5):360-365. doi:10. 1097/MCO.0000000000000485
  • Chang Y, Guo X, Li T, Li S, Guo J, Sun Y. A body shape index and body roundness index: two new body indices to identify left ventricular hypertrophy among rural populations in Northeast China. Heart Lung Circ. 2016;25(4):358-364. doi:10.1016/j.hlc.2015.08.009
  • Maessen MF, Eijsvogels TM, Verheggen RJ, Hopman MT, Verbeek AL, de Vegt F. Entering a new era of body indices: the feasibility of a body shape index and body roundness index to identify cardiovascular health status. PLoS One. 2014;9(9):e107212. doi:10.1371/journal.pone.0107212
  • Thomas DM, Bredlau C, Bosy-Westphal A, et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring). 2013;21(11):2264-2271. doi:10.1002/oby.20408
  • Zhang N, Chang Y, Guo X, Chen Y, Ye N, Sun Y. A body shape index and body roundness index: two new body indices for detecting association between obesity and hyperuricemia in rural area of China. Eur J Intern Med. 2016;29:32-36. doi:10.1016/j.ejim.2016.01.019
  • Yilmaz Y, Yesil A, Gerin F, et al. Detection of hepatic steatosis using the controlled attenuation parameter: a comparative study with liver biopsy. Scand J Gastroenterol. 2014;49(5):611-616. doi:10.3109/00365521. 2014.881548
  • Andronescu CI, Purcarea MR, Babes PA. Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications. J Med Life. 2018;11(1):20-23.
  • Wijarnpreecha K, Panjawatanan P, Aby E, Ahmed A, Kim D. Nonalcoholic fatty liver disease in the over-60s: Impact of sarcopenia and obesity. Maturitas. 2019;124:48-54. doi:10.1016/j.maturitas.2019.03.016
  • Nagral A, Bangar M, Menezes S, et al. Gender differences in nonalcoholic fatty liver disease. Euroasian J Hepatogastroenterol. 2022;12(Suppl 1): S19-S25. doi:10.5005/jp-journals-10018-1370
  • Català-Senent JF, Hidalgo MR, Berenguer M, et al. Sex differences in the progression from NAFL to NASH: a functional meta-analysis of transcriptomic studies medRxiv preprint. medRxiv. 2020.06.03.20118570; doi:10.1101/2020.06.03.20118570
  • Khalid Y, Dasu N, Suga H, et al. Increased incidence and prevalence of cardiovascular events and mortality in female patients with NAFLD: a meta-analysis and meta-regression. Int J Clin Cardiol. 2020;7(4):1-13. doi:10.23937/2378-2951/1410187
  • Cai MJ, Kong XN, Zhao XY. Influences of gender and age on the prevalence and complications of nonalcoholic fatty liver disease. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2017;39(4):499-505. doi:10. 3881/j.issn.1000-503X.2017.04.007
  • Mahli A, Hellerbrand C. Alcohol and obesity: a dangerous association for fatty liver disease. Dig Dis. 2016;34(Suppl 1):p.32-39. doi:10.1159/ 000447279
  • Li L, Liu DW, Yan HY, Wang ZY, Zhao SH, Wang B. Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies. Obes Rev. 2016;17(6):510-519. doi:10.1111/obr.12407
  • Frankenfield DC, Rowe WA, Cooney RN, Smith JS, Becker D. Limits of body mass index to detect obesity and predict body composition. Nutrition. 2001;17(1):26-30. doi:10.1016/s0899-9007(00) 00471-8
  • Tian T, Zhang J, Zhu Q, Xie W, Wang Y, Dai Y. Predicting value of five anthropometric measures in metabolic syndrome among Jiangsu Province, China. BMC Public Health. 2020;20(1):1317. doi:10.1186/s12889-020-09423-9
  • Khan SH, Hafeez A, Khan Y, Chaudhry N, Khalid UB, Shah S. Differences between conventional and newer anthropometric measures among individuals with and without fatty liver disease. J Coll Physicians Surg Pak. 2023;33(11):1327-1329. doi:10.29271/jcpsp.2023.11.1327
  • Stefanescu A, Revilla L, Lopez T, Sanchez SE, Williams MA, Gelaye B. Using a body shape index (ABSI) and body roundness index (BRI) to predict risk of metabolic syndrome in Peruvian adults. J Int Med Res. 2020;48(1):300060519848854. doi:10.1177/0300060519848854
  • Motamed N, Rabiee B, Hemasi GR, et al. Body roundness index and waist-to-height ratio are strongly associated with non-alcoholic fatty liver disease: a population-based study. Hepat Mon. 2016;16(9):e39575. doi:10.5812/hepatmon.39575
  • Tian X, Ding N, Su Y, Qin J. Comparison of obesity-related indicators for nonalcoholic fatty liver disease diagnosed by transient elastography. Turk J Gastroenterol. 2023;34(10):1078-1087. doi:10.5152/tjg.2023.23101
  • Xie F, Pei Y, Zhou Q, Cao D, Wang Y. Comparison of obesity-related indices for identifying nonalcoholic fatty liver disease: a population-based cross-sectional study in China. Lipids Health Dis. 2021;20(1):132. doi:10.1186/s12944-021-01560-3
  • Wang H, Zhang Y, Liu Y, et al. Comparison between traditional and new obesity measurement index for screening metabolic associated fatty liver disease. Front Endocrinol (Lausanne). 2023;14:1163682. doi:10. 3389/fendo.2023.1163682

Comparative diagnostic value of novel and traditional anthropometric indices in FibroScan-diagnosed NAFLD among Turkish adults

Yıl 2025, Cilt: 6 Sayı: 2, 78 - 84, 23.03.2025
https://doi.org/10.47582/jompac.1626490

Öz

ABSTRACT
Background/Aim: Nonalcoholic fatty liver disease (NAFLD) is a growing global health concern associated with chronic liver damage and metabolic comorbidities. Traditional anthropometric measures—such as body mass index (BMI) and waist circumference (WC)—have known limitations. This study aimed to compare the diagnostic performance of novel obesity indices, including A Body Shape Index (ABSI) and Body Roundness Index (BRI), with conventional parameters in predicting NAFLD.
Methods: In this retrospective study, 430 Turkish adults (aged 18–74 years) who underwent FibroScan examinations were evaluated. Anthropometric data (body weight, height, WC) and controlled attenuation parameter (CAP) values were collected. NAFLD was defined as CAP ≥257 dB/m. Predictive capabilities of each anthropometric index (BMI, WC, ABSI, BRI, waist-to-height ratio [WHtR], and body weight) were compared using receiver operating characteristic (ROC) curve analyses.
Results: Body weight displayed the highest area under the ROC curve (AUC) for diagnosing NAFLD, followed by BMI and WC with comparable performance. In contrast, BRI and WHtR demonstrated lower AUC values, whereas ABSI showed insufficient discriminatory ability. Males were more commonly affected by NAFLD, which is consistent with previous literature.
Conclusion: Among Turkish patients diagnosed via FibroScan, body weight emerged as the strongest predictor of NAFLD, with BMI and WC remaining reliable alternatives. Novel indices such as BRI and ABSI showed limited utility for clinical diagnosis. These findings highlight the continued relevance of simple and traditional measurements for identifying NAFLD risk.

Kaynakça

  • Sanyal AJ, Brunt EM, Kleiner DE, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54(1):344-353. doi:10.1002/hep.24376
  • Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American association for the study of liver diseases. Hepatology. 2018;67(1):328-357. doi:10.1002/hep.29367
  • European association for the study of the liver (EASL); European association for the study of diabetes (EASD); European association for the study of obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. doi:10. 1016/j.jhep.2024.04.031
  • Calzadilla Bertot L, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci. 2016;17(5):774. doi:10.3390/ijms17050774
  • Ekstedt M, Nasr P, Kechagias S. Natural history of NAFLD/NASH. Curr Hepatol Rep. 2017;16(4):391-397. doi:10.1007/s11901-017-0378-2
  • GBD 2019 diseases and injuries collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
  • Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016; 64(1):73-84. doi:10.1002/hep.28431
  • Farrell GC, Wong VW, Chitturi S. NAFLD in Asia--as common and important as in the West. Nat Rev Gastroenterol Hepatol. 2013;10(5):307-318. doi:10.1038/nrgastro.2013.34
  • Polyzos SA, Kountouras J, Mantzoros CS. Obesity and nonalcoholic fatty liver disease: from pathophysiology to therapeutics. Metabolism. 2019;92:82-97. doi:10.1016/j.metabol.2018.11.014
  • VanWagner LB, Khan SS, Ning H, et al. Body-mass index trajectories in young adulthood predict non-alcoholic fatty liver disease in middle age: the CARDIA cohort study. Liver Int. 2018;38(4):706-714. doi:10.1111/liv. 13603
  • Pang Q, Zhang JY, Song SD, et al. Central obesity and nonalcoholic fatty liver disease risk after adjusting for body-mass index. World J Gastroenterol. 2015;21(5):1650-1662. doi:10.3748/wjg.v21.i5.1650
  • Xing J, Guan X, Zhang Q, Chen S, Wu S, Sun X. Triglycerides mediate body-mass index and nonalcoholic fatty liver disease: a population-based study. Obes Facts. 2021;14(2):190-196. doi:10.1159/000514848
  • Church TS, Kuk JL, Ross R, Priest EL, Biltoft E, Blair SN. Association of cardiorespiratory fitness, body mass index, and waist circumference to nonalcoholic fatty liver disease. Gastroenterology. 2006;130(7):2023-2030. doi:10.1053/j.gastro.2006.03.019
  • Kim D, Chung GE, Kwak MS, et al. Body fat distribution and risk of incident and regressed nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2016;14(1):132-8.e4. doi:10.1016/j.cgh.2015.07.024
  • Moore JB. Non-alcoholic fatty liver disease: the hepatic consequence of obesity and the metabolic syndrome. Proc Nutr Soc. 2010;69(2):211-220. doi:10.1017/S0029665110000030
  • Blundell JE, Dulloo AG, Salvador J, Frühbeck G; EASO SAB Working Group on BMI. Beyond BMI--phenotyping the obesities. Obes Facts. 2014;7(5):322-328. doi:10.1159/000368783
  • Michels KB, Greenland S, Rosner BA. Does body-mass index adequately capture the relation of body composition and body size to health outcomes? Am J Epidemiol. 1998;147(2):167-172. doi:10.1093/oxfordjournals.aje.a009430
  • Fang H, Berg E, Cheng X, Shen W. How to best assess abdominal obesity. Curr Opin Clin Nutr Metab Care. 2018;21(5):360-365. doi:10. 1097/MCO.0000000000000485
  • Chang Y, Guo X, Li T, Li S, Guo J, Sun Y. A body shape index and body roundness index: two new body indices to identify left ventricular hypertrophy among rural populations in Northeast China. Heart Lung Circ. 2016;25(4):358-364. doi:10.1016/j.hlc.2015.08.009
  • Maessen MF, Eijsvogels TM, Verheggen RJ, Hopman MT, Verbeek AL, de Vegt F. Entering a new era of body indices: the feasibility of a body shape index and body roundness index to identify cardiovascular health status. PLoS One. 2014;9(9):e107212. doi:10.1371/journal.pone.0107212
  • Thomas DM, Bredlau C, Bosy-Westphal A, et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring). 2013;21(11):2264-2271. doi:10.1002/oby.20408
  • Zhang N, Chang Y, Guo X, Chen Y, Ye N, Sun Y. A body shape index and body roundness index: two new body indices for detecting association between obesity and hyperuricemia in rural area of China. Eur J Intern Med. 2016;29:32-36. doi:10.1016/j.ejim.2016.01.019
  • Yilmaz Y, Yesil A, Gerin F, et al. Detection of hepatic steatosis using the controlled attenuation parameter: a comparative study with liver biopsy. Scand J Gastroenterol. 2014;49(5):611-616. doi:10.3109/00365521. 2014.881548
  • Andronescu CI, Purcarea MR, Babes PA. Nonalcoholic fatty liver disease: epidemiology, pathogenesis and therapeutic implications. J Med Life. 2018;11(1):20-23.
  • Wijarnpreecha K, Panjawatanan P, Aby E, Ahmed A, Kim D. Nonalcoholic fatty liver disease in the over-60s: Impact of sarcopenia and obesity. Maturitas. 2019;124:48-54. doi:10.1016/j.maturitas.2019.03.016
  • Nagral A, Bangar M, Menezes S, et al. Gender differences in nonalcoholic fatty liver disease. Euroasian J Hepatogastroenterol. 2022;12(Suppl 1): S19-S25. doi:10.5005/jp-journals-10018-1370
  • Català-Senent JF, Hidalgo MR, Berenguer M, et al. Sex differences in the progression from NAFL to NASH: a functional meta-analysis of transcriptomic studies medRxiv preprint. medRxiv. 2020.06.03.20118570; doi:10.1101/2020.06.03.20118570
  • Khalid Y, Dasu N, Suga H, et al. Increased incidence and prevalence of cardiovascular events and mortality in female patients with NAFLD: a meta-analysis and meta-regression. Int J Clin Cardiol. 2020;7(4):1-13. doi:10.23937/2378-2951/1410187
  • Cai MJ, Kong XN, Zhao XY. Influences of gender and age on the prevalence and complications of nonalcoholic fatty liver disease. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2017;39(4):499-505. doi:10. 3881/j.issn.1000-503X.2017.04.007
  • Mahli A, Hellerbrand C. Alcohol and obesity: a dangerous association for fatty liver disease. Dig Dis. 2016;34(Suppl 1):p.32-39. doi:10.1159/ 000447279
  • Li L, Liu DW, Yan HY, Wang ZY, Zhao SH, Wang B. Obesity is an independent risk factor for non-alcoholic fatty liver disease: evidence from a meta-analysis of 21 cohort studies. Obes Rev. 2016;17(6):510-519. doi:10.1111/obr.12407
  • Frankenfield DC, Rowe WA, Cooney RN, Smith JS, Becker D. Limits of body mass index to detect obesity and predict body composition. Nutrition. 2001;17(1):26-30. doi:10.1016/s0899-9007(00) 00471-8
  • Tian T, Zhang J, Zhu Q, Xie W, Wang Y, Dai Y. Predicting value of five anthropometric measures in metabolic syndrome among Jiangsu Province, China. BMC Public Health. 2020;20(1):1317. doi:10.1186/s12889-020-09423-9
  • Khan SH, Hafeez A, Khan Y, Chaudhry N, Khalid UB, Shah S. Differences between conventional and newer anthropometric measures among individuals with and without fatty liver disease. J Coll Physicians Surg Pak. 2023;33(11):1327-1329. doi:10.29271/jcpsp.2023.11.1327
  • Stefanescu A, Revilla L, Lopez T, Sanchez SE, Williams MA, Gelaye B. Using a body shape index (ABSI) and body roundness index (BRI) to predict risk of metabolic syndrome in Peruvian adults. J Int Med Res. 2020;48(1):300060519848854. doi:10.1177/0300060519848854
  • Motamed N, Rabiee B, Hemasi GR, et al. Body roundness index and waist-to-height ratio are strongly associated with non-alcoholic fatty liver disease: a population-based study. Hepat Mon. 2016;16(9):e39575. doi:10.5812/hepatmon.39575
  • Tian X, Ding N, Su Y, Qin J. Comparison of obesity-related indicators for nonalcoholic fatty liver disease diagnosed by transient elastography. Turk J Gastroenterol. 2023;34(10):1078-1087. doi:10.5152/tjg.2023.23101
  • Xie F, Pei Y, Zhou Q, Cao D, Wang Y. Comparison of obesity-related indices for identifying nonalcoholic fatty liver disease: a population-based cross-sectional study in China. Lipids Health Dis. 2021;20(1):132. doi:10.1186/s12944-021-01560-3
  • Wang H, Zhang Y, Liu Y, et al. Comparison between traditional and new obesity measurement index for screening metabolic associated fatty liver disease. Front Endocrinol (Lausanne). 2023;14:1163682. doi:10. 3389/fendo.2023.1163682
Toplam 39 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Gastroenteroloji ve Hepatoloji
Bölüm Research Articles [en] Araştırma Makaleleri [tr]
Yazarlar

Murat Keskin 0000-0003-4526-4352

Nizameddin Koca 0000-0003-1457-4366

Yayımlanma Tarihi 23 Mart 2025
Gönderilme Tarihi 24 Ocak 2025
Kabul Tarihi 21 Şubat 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 6 Sayı: 2

Kaynak Göster

AMA Keskin M, Koca N. Comparative diagnostic value of novel and traditional anthropometric indices in FibroScan-diagnosed NAFLD among Turkish adults. J Med Palliat Care / JOMPAC / Jompac. Mart 2025;6(2):78-84. doi:10.47582/jompac.1626490

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