Fatty liver index (FLI) and prediction of new cases of non-alcoholic fatty liver disease: A population-based study of northern Iran

Motamed, Nima; Faraji, Amir H.; Khonsari, Mahmood Reza; Maadi, Mansooreh; Tameshkel, Fahimeh Safarnezhad; Keyvani, Hossein; Ajdarkosh, Hossein; Niya, Mohammad Hadi Karbalaie; Rezaie, Nader; Zamani, Farhad

doi:10.1016/j.clnu.2019.02.024

Cited by 36 publications

(39 citation statements)

References 24 publications

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“…The gold standard for the diagnosis of NAFLD is the liver biopsy, even though non-invasive techniques, such as magnetic resonance imaging, computed tomography, and liver ultrasonography report adequate concordance with histological results ( 19 ). The fatty liver index (FLI), a simple algorithm based on parameters that are routine measurements in clinical practice, such as body mass index (BMI), waist circumference (WC), triglycerides (TGs) and glutamyltransferase (GGT), shows a high concordance with the liver imaging techniques and the histological criteria representing a useful tool to predict the presence of NAFLD ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

Cardio-Metabolic Indices and Metabolic Syndrome as Predictors of Clinical Severity of Gastroenteropancreatic Neuroendocrine Tumors

Barrea

Muscogiuri²,

Modica³

et al. 2021

Front. Endocrinol.

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BackgroundObesity, mainly visceral obesity, and metabolic syndrome (MetS) are major risk factors for the development of type 2 diabetes, cardiovascular diseases, and cancer. Data analyzing the association of obesity and MetS with gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) are lacking. Fatty liver index (FLI) is a non-invasive tool for identifying individuals with non-alcoholic fatty liver disease (NAFLD). Visceral adiposity index (VAI) has been suggested as a gender-specific indicator of adipose dysfunction. Both indexes have been proposed as early predictors of MetS. This study aimed to investigate the association of FLI VAI as early predictors of MetS with gastroenteropancreatic neuroendocrine tumors (GEP-NETs).MethodsA cross-sectional, case–control, observational study was carried out at the ENETS Centers of Excellence Multidisciplinary Group for Neuroendocrine Tumors, University “Federico II”. VAI and FLI were calculated.ResultsWe enrolled 109 patients with histologically confirmed G1/G2 GEP-NET (53 M; 57.06 ± 15.96 years), as well as 109 healthy subjects, age, sex- and body mass index-matched. Forty-four GEP-NET patients were G2, of which 21 were with progressive disease, and 27 patients had metastases. GEP-NET patients had a higher value of VAI (p < 0.001) and FLI (p = 0.049) and higher MetS presence (p < 0.001) compared with controls. VAI and FLI values and MetS presence were higher in G2 than in G1 patients (p < 0.001), in patients with progressive disease, and in metastatic vs non-metastatic patients (p < 0.001). In addition, higher values of VAI and FLI and higher MetS presence were significantly correlated with the worst clinical severity of NENs. The cut-off values for the FLI and MetS to predict high grading of GEP-NETs and the presence of metastasis were also provided.ConclusionsThis is the first study investigating an association between VAI and FLI as early predictors of MetS and GEP-NET. Our findings report that the worsening of clinicopathological characteristics in GEP-NET is associated with higher presence of MetS, NAFLD, evaluated by FLI, and visceral adiposity dysfunction, evaluated by VAI. Addressing the clinical evaluation of MetS presence, NAFLD, and visceral adiposity dysfunction might be of crucial relevance to establish targeted preventive and treatment interventions of NEN-related metabolic comorbidities.

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Section: Introductionmentioning

confidence: 99%

Cardio-Metabolic Indices and Metabolic Syndrome as Predictors of Clinical Severity of Gastroenteropancreatic Neuroendocrine Tumors

Barrea

Muscogiuri²,

Modica³

et al. 2021

Front. Endocrinol.

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“…The FLI is less invasive and more cost effective; it is based on anthropometric measurements of BMI, WC, and serum levels of TGs and GGT (10). A recent study showed that the FLI predicted new cases of NAFLD (46). Therefore, repeated measurement of FLI can be easily and effectively used for the detection of NAFLD in a large general population.…”

Section: Discussionmentioning

confidence: 99%

The Repeatedly Elevated Fatty Liver Index Is Associated With Increased Mortality: A Population-Based Cohort Study

et al. 2021

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AimsNon-alcoholic fatty liver disease (NAFLD) has a dynamic disease course, therefore repeated measurements of NAFLD status could have benefits rather than single one. The aim of this study was to investigate the effects of persistent NAFLD on the incidence of myocardial infarction (MI) and stroke and all-cause mortality by using repeated measurement of fatty liver index (FLI).MethodsAbout 3 million subjects who had undergone the health screening four times from 2009 until 2013 were included. NAFLD was defined as an FLI ≥60. FLI points were defined as the number of times participants meeting the criteria of NAFLD (0–4). Outcomes included all-cause mortality, MI, and stroke.ResultsThe higher the FLI points, the higher the risk of all-cause mortality, MI, and stroke (P for trend <0.001, all). Subjects with four FLI points had a higher risk of all-cause mortality (aHR, 1.86; 95% CI, 1.75–1.98; P < 0.001), incidence of MI (aHR, 1.3; 95% CI, 1.21–1.40; P < 0.001), and stroke (aHR, 1.27; 95% CI, 1.19–1.37; P < 0.001) after adjustment for age, sex, smoking, alcohol consumption, income, hypertension, dyslipidemia, diabetes, body mass index, and physical activity. When the 1st and the last FLI were compared, the “incident NAFLD” group had a higher risk for death compared to the “no NAFLD” group (aHR, 1.46; 95% CI, 1.37–1.55), and the “regression of NAFLD” group had a decreased risk for death compared to the “persistent NAFLD” group (aHR, 0.83; 95% CI, 0.77–0.89).ConclusionRepeated evaluations of NAFLD status based on FLI measurements could help physicians identify higher-risk groups in terms of mortality, MI, and stroke. The association between FLI worsening or improvement and outcomes also suggests clinical benefits of the prevention and treatment of NAFLD.

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“…On the one hand, Fatty Liver Index has been highly correlated with measures of fatty liver disease showing an area under the curve of 0.84, predicting most cases of NAFLD [62,63]. Moreover, a recent study reported that the FLI joint to the waist circumference-to-height ratio could be one of the most accurate algorithms for the noninvasive diagnosis of NAFLD in both lean and overweight/obese population [64,65]. On the other hand, MRI can be considered the gold standard for steatosis measurement being highly accurate and reproducible and superior in detecting and quantifying fat accumulation [61,66].…”

Section: Discussionmentioning

confidence: 99%

Three different genetic risk scores based on Fatty Liver Index, Magnetic Resonance Imaging and lipidomic for a nutrigenetic personalized management of NAFLD: the Fatty Liver in Obesity study

Riezu‐Boj

Marín-Alejandre

Monreal

et al. 2021

Preprint

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Background Non-alcoholic fatty liver disease (NAFLD) affects 25% of the global population. The pathogenesis of NAFLD is complex where available data unveils that genetics and ascribed interactions with environmental factors may play an important role in the development of this morbid condition. The purpose of this investigation was to assess genetic and non-genetic determinants putatively involved in the onset and progression of NAFLD after a 6-months weight-loss nutritional treatment. Methods A group of 86 overweight/obese subjects with NAFLD from the Fatty Liver in Obesity (FLiO) study were enrolled and metabolically evaluated at baseline and after 6-months. Also, a total of 95 single nucleotide polymorphisms (SNPs) related to obesity and weight loss were analyzed by a targeted next-generation sequencing system. Three genetic risk scores (GRS) concerning the improvement on hepatic health evaluated by minimally invasive methods such as the Fatty Liver Index (FLI) (GRSFLI), lipidomic-OWLiver®-test (GRSOWL) and Magnetic Resonance Imaging (MRI) (GRSMRI), were derived by adding the risk alleles genotypes. Body composition, liver injury-related markers and dietary intake were also monitored. Results Overall, 26 SNPs were independently associated with the change on FLI, 16 SNPs with OWLiver®-test and 8 SNPs with MRI, which were specific for every diagnosis tool. After adjusting for gender, age and other related predictors (insulin resistance, inflammatory biomarkers and dietary intake at baseline) the calculated GRSFLI, GRSOWL and GRSMRI were major contributors of the improvement on hepatic status. Thus, fitted linear regression models showed a variance of 53% (adj. R2 = 0.53) in hepatic functionality (FLI), 16% (adj. R2 = 0.16) in lipidomic metabolism (OWLiver®-test) and 34% (adj. R2 = 0.34) in liver fat content (MRI). Conclusion These results demonstrate that three different genetic scores can be useful for the personalized management of NAFLD, whose treatment must rely on specific dietary recommendations guided by the measurement of specific genetic biomarkers. Trial registration: The FLiO study: Fatty Liver in Obesity study, NCT03183193. Registered 12 June 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03183193

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Fatty liver index (FLI) and prediction of new cases of non-alcoholic fatty liver disease: A population-based study of northern Iran

Cited by 36 publications

References 24 publications

Cardio-Metabolic Indices and Metabolic Syndrome as Predictors of Clinical Severity of Gastroenteropancreatic Neuroendocrine Tumors

Cardio-Metabolic Indices and Metabolic Syndrome as Predictors of Clinical Severity of Gastroenteropancreatic Neuroendocrine Tumors

The Repeatedly Elevated Fatty Liver Index Is Associated With Increased Mortality: A Population-Based Cohort Study

Three different genetic risk scores based on Fatty Liver Index, Magnetic Resonance Imaging and lipidomic for a nutrigenetic personalized management of NAFLD: the Fatty Liver in Obesity study

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