Fatty liver index as a predictor of increased risk of cardiometabolic disease: finding from the Kuopio Ischaemic Heart Disease Risk Factor Study Cohort

Abstract

ObjectiveFatty liver disease (FLD), a global epidemic, is also a predictor of cardiometabolic disease (CMD) (type 2 diabetes or cardiovascular disease). Our objective was to examine whether progressive FLD, as assessed by fatty liver index (FLI), predicts increasing future CMD risk compared with relatively stable FLD, among middle-aged men.DesignProspective epidemiological study.SettingUniversity affiliated research centre in Kuopio, Eastern Finland.ParticipantsOur subjects were 501 men without CMD during the initial 4-year follow-up in the Kuopio Ischaemic Heart Disease Risk Factor Study cohort.Outcome measureOver the initial 4-year follow-up, 135 men (26.9%) had a significant (≥10) FLI increase. The association of 4-year FLI increase with incident CMD was analysed in multivariable-adjusted Cox regression models, adjusting for baseline constitutional and lifestyle factors (model 1) and, in addition, metabolic and inflammation biomarker factors (model 2).ResultsDuring a mean follow-up of 15 years, 301 new CMD cases occurred. We used subjects with low baseline FLI and no significant 4-year FLI increase as the reference. For subjects with intermediate baseline FLI and significant 4-year FLI increase, the HRs and 95% CIs for incident CMD in model 1 (2.13 (1.45 to 3.13)) and model 2 (1.73 (1.13 to 2.66)) exceeded values for subjects with similar baseline FLI without a significant 4-year change (HRs (95% CIs) were 1.36 (0.94 to 1.97) for model 1 and 1.18 (0.81 to 1.70) for model 2). They approached HRs (95% CI) for subjects who maintained high FLI over the 4 years (HRs (95% CIs) were 2.18 (1.54 to 3.10) in model 1 and 1.85 (1.21 to 2.82) in model 2).ConclusionPersons with significant FLI increase are likely with increasing CMD risk. Such persons should be evaluated for progressive FLD and CMD and managed to reduce CMD risk.

Fatty liver index and development of cardiovascular disease in Koreans without pre-existing myocardial infarction and ischemic stroke: a large population-based study

“…Another limitation of our study was the use of the FLI as a surrogate measure of NAFLD instead of histological assessment of NAFLD. Furthermore, because FLI comprises known CV risk factors (BMI, triglyceride levels, waist circumference) [28,32], these variables account for the associations observed in the current study. However, to overcome this limitation, we conducted analyses stratified by the presence or absence of these CV risk factors.…”

Population-specific cut-off points of fatty liver index: a study based on the National Health and Nutrition Examination Survey data

“…Several studies demonstrated that the FLI had excellent discriminative ability to detect ultrasonographic HS, and outperforms other non-invasive markers such as BMI, WC, TG, cholesterol and so on [ 18 – 20 ]. Furthermore, in addition to predicting HS, studies had shown that FLI was also associated with metabolic and cardiovascular disease, and all-cause mortality [ 21 – 23 ]. Therefore, FLI has great clinical application value in health screening and epidemiologic studies, particularly when ultrasound and other imaging examinations are unavailable.…”

Fatty liver index and development of cardiovascular disease in Koreans without pre-existing myocardial infarction and ischemic stroke: a large population-based study

“…Another limitation of our study was the use of the FLI as a surrogate measure of NAFLD instead of histological assessment of NAFLD. Furthermore, because FLI comprises known CV risk factors (BMI, triglyceride levels, waist circumference) [28,32], these variables account for the associations observed in the current study. However, to overcome this limitation, we conducted analyses stratified by the presence or absence of these CV risk factors.…”