BackgroundFatty 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.Methods216 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.ResultsAn 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 ≥ 60 (positive likelihood ratio = 4.3) rules in fatty liver.ConclusionFLI 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.

No abstract

Using the general population of the Dionysos Study, we followed up 144 subjects without fatty liver (FL ؊ ) and 336 with fatty liver (FL ؉ ) for a median time of 8.5 years. All subjects had suspected liver disease (SLD) defined as altered liver enzymes, high mean corpuscular volume, or low platelet count in the absence of HBV and HCV infection. Ethanol intake was assessed using a food frequency questionnaire, and FL was diagnosed using ultrasonography. The incidence and remission rates of FL were 18.5 and 55.0 per 1,000 person-years. Progression to cirrhosis or HCC was rare in both cohorts (incidence rate: 1.7 versus 1.1 and 0.8 versus 0.4 per 1,000 person-years for FL ؊ versus FL ؉ ). Multivariable Poisson regression was performed to identify predictors of FL incidence and remission among sex, age, body mass index, ethanol, and liver enzymes. Every increase of 20 g/day of ethanol intake at baseline was associated with a 17% increase in the rate of incident FL (P ‫؍‬ 0.019), a 10% decrease in the rate of remitting FL and SLD (P ‫؍‬ 0.043), a 19% decrease in the rate of remitting FL with persistent SLD (P ‫؍‬ 0.002), and a 10% increase in mortality rate (P ‫؍‬ 0.005) in the FL ؉ cohort. Conclusion: In the general population of the Dionysos Study, FL regressed in nearly 1 of every 2 cases and had a substantially benign course. Ethanol intake was the most important risk factor for FL remission and incidence and a predictor of mortality in subjects with FL. (HEPATOLOGY 2007;46:1387-1391 R ecent studies performed in representative samples of the general population have shown that fatty liver (FL) is highly prevalent and that anthropometric and metabolic indicators are better predictors of FL than ethanol intake. 1-4 Data are still lacking, however, on the incidence and natural course of FL in the general population. 5 The incidence and remission rates of nonalcoholic fatty liver disease (NAFLD) were 10% and 16%, respectively, in a convenience sample of 4,401 Japanese employees followed for a mean time of 1.1 years. 6 The survival of a community-based sample of NAFLD patients was lower than that of the general population (standardized mortality rate [SMR], 1.34; 95% CI, 1.003-1.76) and 5% of them developed cirrhosis after a mean (SD) time of 7.6 (4.0) years. 7 In the largest clinical study performed to date, 5% of a convenience sample of 129 hospitalized NAFLD patients developed end-stage liver disease after a mean follow-up time of 13.7 years. 8 Referral bias may be responsible for the relatively high incidence of cirrhosis observed in community-and hospitalbased cohorts. 5,7,9 Indeed, there is an ongoing controversy as to whether NAFLD should be considered a benign disease. 10,11 Using data from the follow-up of the Dionysos Study, we evaluated the incidence and natural course of FL in a representative sample of the general population. Patients and MethodsStudy Design. The purpose of the Dionysos Study was to assess the prevalence, incidence, and natural course of liver disease in the general population of 2 towns o...

Periodontitis was highly prevalent in the Turin population. The present data will enable development of appropriate public health programs and allocation of resources.