Validation of the Fatty Liver Index for Nonalcoholic Fatty Liver Disease in Middle-Aged and Elderly Chinese

Abstract

The fatty liver index (FLI), which is an algorithm based on waist circumference, body mass index (BMI), triglyceride, and gamma-glutamyl-transferase (GGT), was initially developed to detect fatty liver in Western countries. Our study aimed to evaluate the accuracy and optimal cut-off point of the FLI for predicting nonalcoholic fatty liver disease (NAFLD) in middle-aged and elderly Chinese.This cross-sectional study included 8626 Chinese adults aged 40 years or above recruited from Jiading District, Shanghai, China. Anthropometric and biochemical features were collected by a standard protocol. NAFLD was diagnosed by hepatic ultrasonography. The accuracy and cut-off point of the FLI to detect NAFLD were evaluated by area under the receiver operator characteristic curve (AUROC) and the maximum Youden index analysis, respectively.The AUROC of the FLI for NAFLD was 0.834 (95% confidence interval: 0.825–0.842), and larger than that of its each individual component [0.786 (0.776–0.796), 0.783 (0.773–0.793), 0.727 (0.716–0.739), and 0.707 (0.695–0.719) for waist circumference, BMI, triglyceride, and GGT, respectively] (all P < .001). The optimal cut-off point of the FLI for diagnosing NAFLD was 30 with the maximum Youden Index of 0.51, achieving a high sensitivity of 79.89% and a specificity of 71.51%. The FLI-diagnosed NAFLD individuals were in worse metabolic characteristics (waist circumference, BMI, blood pressure, serum lipids, and aminotransferases) than ultrasonography-diagnosed NAFLD patients (all P < .05).The FLI could accurately identify NAFLD and the optimal cut-off point was 30 in middle-aged and elderly Chinese. As FLI-diagnosed NAFLD patients were in worse metabolism, much attention should be paid to the metabolic controls and managements of NAFLD.

Non‐alcoholic fatty liver and advanced fibrosis in the elderly: Results from a community‐based Polish survey

“…In our household survey, the diagnosis of NAFL was based on the fatty liver index (FLI), an algorithm derived from the population of the Dionysos Nutrition and Liver Study . An optimal cut‐off value for FLI to detect fatty liver is still the subject of debate, and in a recent Chinese study, a value of 30 was shown to have better diagnostic sensitivity than a value of 60 . To avoid overestimating the NAFL population in our study, as in many others, 60 was assumed to be the discriminative point.…”

Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B

“…The equations are described in Table S1. Serum albumin was not measured in the KNHANES; therefore, significant fibrosis was defined as either the highest quartile of the NAFLD fibrosis score, the highest quintile of Forns index, or fibrosis‐4 index ≥2.67, whereas a fatty liver index ≥30 or a comprehensive NAFLD score ≥40 was considered indicative of a fatty liver …”

Validation of simple indexes for nonalcoholic fatty liver disease in western China: a retrospective cross-sectional study

“…A series of predicting indexes was developed and validated individually in Europe and Asia [10,26,27]. Few studies were conducted to appraise indexes in western China, which witnesses a variety of differences in culture, diet and lifestyle in comparison to eastern China.…”

“…The fatty liver index (FLI) [5], the hepatic steatosis index (HSI) [6] and lipid accumulation product (LAP) [7] have been derived and utilized to screen hepatic steatosis in large epidemiologic studies or identify potential patients for further examination in clinical practice. The evaluation of the indexes' diagnostic performance has been reported in Europe [8] and Asia [9,10] over the past decade; however, external validation of them in western China is rare.…”