Abstract
Background and AimsThe fatty liver index (FLI) is an algorithm involving the waist circumference, body mass index, and serum levels of triglyceride and gamma-glutamyl transferase to identify fatty liver. Although some studies have attempted to validate the FLI, few studies have been conducted for external validation among Asians. We attempted to validate FLI to predict ultrasonographic fatty liver in Taiwanese subjects.MethodsWe enrolled consecutive subjects who received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009. Ultrasonography was applied to diagnose fatty liver. The ability of the FLI to detect ultrasonographic fatty liver was assessed by analyzing the area under the receiver operating characteristic (AUROC) curve.ResultsAmong the 29,797 subjects enrolled in this study, fatty liver was diagnosed in 44.5% of the population. Subjects with ultrasonographic fatty liver had a significantly higher FLI than those without fatty liver by multivariate analysis (odds ratio 1.045; 95% confidence interval, CI 1.044–1.047, p< 0.001). Moreover, FLI had the best discriminative ability to identify patients with ultrasonographic fatty liver (AUROC: 0.827, 95% confidence interval, 0.822–0.831). An FLI < 25 (negative likelihood ratio (LR−) 0.32) for males and <10 (LR− 0.26) for females rule out ultrasonographic fatty liver. Moreover, an FLI ≥ 35 (positive likelihood ratio (LR+) 3.12) for males and ≥ 20 (LR+ 4.43) for females rule in ultrasonographic fatty liver.ConclusionsFLI could accurately identify ultrasonographic fatty liver in a large-scale population in Taiwan but with lower cut-off value than the Western population. Meanwhile the cut-off value was lower in females than in males.
Highlights
Fatty liver disease has become an emerging public health concern because its prevalence and incidence rates have rapidly increased in recent decades [1,2]
Among the 29,797 subjects enrolled in this study, fatty liver was diagnosed in 44.5% of the population
Subjects with ultrasonographic fatty liver had a significantly higher fatty liver index (FLI) than those without fatty liver by multivariate analysis
Summary
Fatty liver disease has become an emerging public health concern because its prevalence and incidence rates have rapidly increased in recent decades [1,2]. With different study populations and diagnostic tools, the prevalence rate of fatty liver disease has been reported to be 10–35% in the United States. Due to the Westernization of diet and lifestyle and the aging population, the prevalence rate of fatty liver is increasing in Asian countries. The prevalence of fatty liver-related cirrhosis has markedly increased in recent years as the underlying liver disease among patients undergoing transplants for HCC in the United States [10,11]. Welzel et al further demonstrated that diabetes and/or obesity had the largest population-attributable fractions of HCC, with a value of 36.6% [12] This rate is significantly higher than that of viral hepatitis, suggesting a dominant role of fatty liver and metabolic disorders for hepatic carcinogenesis. We attempted to validate FLI to predict ultrasonographic fatty liver in Taiwanese subjects
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