The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population

TLDR

Fatty liver is the most common liver disease in Western countries, yet external validation of predictive tools is still required. The study aimed to develop a simple, accurate algorithm for predicting fatty liver in the general population using data from the Dionysos Nutrition & Liver Study. Using ultrasonography, a 7‑day alcohol diary, and bootstrapped stepwise logistic regression on 13 variables, the authors derived a 0–100‑point fatty liver index based on BMI, waist circumference, triglycerides, and GGT. The fatty liver index achieved 84 % accuracy, with scores <30 effectively ruling out fatty liver and scores ≥60 ruling it in, offering a practical tool for clinicians and researchers.

Abstract

Fatty liver (FL) is the most frequent liver disease in Western countries. We used data from the Dionysos Nutrition & Liver Study to develop a simple algorithm for the prediction of FL in the general population.216 subjects with and 280 without suspected liver disease were studied. FL was diagnosed by ultrasonography and alcohol intake was assessed using a 7-day diary. Bootstrapped stepwise logistic regression was used to identify potential predictors of FL among 13 variables of interest [gender, age, ethanol intake, alanine transaminase, aspartate transaminase, gamma-glutamyl-transferase (GGT), body mass index (BMI), waist circumference, sum of 4 skinfolds, glucose, insulin, triglycerides, and cholesterol]. Potential predictors were entered into stepwise logistic regression models with the aim of obtaining the most simple and accurate algorithm for the prediction of FL.An algorithm based on BMI, waist circumference, triglycerides and GGT had an accuracy of 0.84 (95%CI 0.81-0.87) in detecting FL. We used this algorithm to develop the "fatty liver index" (FLI), which varies between 0 and 100. A FLI < 30 (negative likelihood ratio = 0.2) rules out and a FLI > or = 60 (positive likelihood ratio = 4.3) rules in fatty liver.FLI is simple to obtain and may help physicians select subjects for liver ultrasonography and intensified lifestyle counseling, and researchers to select patients for epidemiologic studies. Validation of FLI in external populations is needed before it can be employed for these purposes.