The Ability of the Framingham Steatosis Index (FSI) to Predict Non-alcoholic Fatty Liver Disease (NAFLD): A Cohort Study

Motamed, Nima; Nikkhah, Mehdi; Niya, Mohammad Hadi Karbalaie; Khoonsari, Mahmoodreza; Perumal, Dhayaneethie; Ashrafi, G. Hossein; Faraji, Amir H.; Maadi, Mansooreh; Ajdarkosh, Hossein; Tameshkel, Fahimeh Safarnezhad; Moradi‐Lakeh, Maziar; Miri, Seyyed Mohammad; Arsang‐Jang, Shahram; Zamani, Farhad

doi:10.1016/j.clinre.2020.10.011

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…Of the components, GGT is an enzyme that indicates liver damage or inflammation, even though an elevated GGT level has been confirmed not to be a specific indicator for fatty liver. Previous research reported promising predictive power of FLI, with AUC values ranging from 0.776 to 0.827 [33,37,40]. This study obtained similar results, confirming the accuracy of FLI in diagnosing MAFLD.…”

Section: Discussionsupporting

confidence: 87%

“…Huang et al [53] indicated that the FLI threshold was 30 for middle-aged and elderly Chinese individuals. As per another investigation conducted in Taiwan [40], FLI > 35 for males and > 20 for females detected ultrasonic fatty liver with high SP. Additionally, Cho et al [52] suggested that a cut-off value of FLI > 31 for males and > 18 for females predicted fatty liver with good accuracy.…”

Section: Discussionsupporting

confidence: 69%

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Four hepatic steatosis indices in predicting quantitative computed tomography-based metabolic dysfunction-associated fatty liver disease

Xu,

Li,

Chen

et al. 2024

Explor Endocr Metab Dis

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Aim: To evaluate the prediction ability for quantitative computed tomography (QCT)-based metabolic dysfunction-associated fatty liver disease (MAFLD) of four widely known hepatic steatosis algorithms, namely the fatty liver index (FLI), the hepatic steatosis index (HSI), the Framingham Steatosis index (FSI) and the Zhejiang University index (ZJU index). Methods: From July 2020 to June 2022, health checkup subjects who accepted liver fat quantification with QCT at the Health Management Center of the Second Affiliated Hospital of Chongqing Medical University were recruited in this study. MAFLD was diagnosed by using QCT-based liver fat quantification. The prediction performance of FLI, HSI, FSI, and ZJU index on MAFLD was evaluated using the area under the receiver operating characteristic curve (AUC). Results: Of a total of 4,566 subjects enrolled in this study, 48.7% were diagnosed with MAFLD. The AUC values of FLI, HSI, FSI, and ZJU index were 0.819, 0.792, 0.822 and 0.826, respectively. FLI exhibited the highest sensitivity (SN) of 79.42%, while the ZJU index demonstrated the highest specificity (SP) of 75.35%. Conclusions: All four indices (FLI, HSI, FSI, and ZJU index) have acceptable predictive performance for patients with QCT-based MAFLD. Our study suggests that the above indices have a stable ability for detecting MAFLD.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 69%

Four hepatic steatosis indices in predicting quantitative computed tomography-based metabolic dysfunction-associated fatty liver disease

Xu,

Li,

Chen

et al. 2024

Explor Endocr Metab Dis

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“…Similar results were observed in the third National Health and Nutrition Examination Survey (NHANES III) cohort sample at the same cut point, although with a lower sensitivity of 62% and higher specificity of 80% for detecting hepatic steatosis (15). In another recent cohort study involving 4,670 people in whom NAFLD was identified via ultrasonography, a good capacity to identify NAFLD with FSI was observed (16). The areas under the curve (AUCs) for the discriminatory and predictive abilities of the FSI in relation to NAFLD were calculated as 0.8421 [95% confidence interval (CI): 0.8314-0.8527] for the prevalence of NAFLD and 0.7093 (95% CI: 0.6863-0.7322) for the incidence of new cases of NAFLD (16).…”

Section: Introductionsupporting

confidence: 72%

Predictive value of the Framingham steatosis index for cardiovascular risk: a nationwide population-based cohort study

Cho

Kim

et al. 2023

Front. Cardiovasc. Med.

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BackgroundNon-alcoholic fatty liver disease (NAFLD) is common and is associated with cardiovascular (CV) disease and mortality. The Framingham steatosis index (FSI) was recently proposed as a diagnostic marker of NAFLD and was calculated from age, body mass index, triglyceride, aspartate aminotransferase, alanine aminotransferase, diabetes history, and hypertension status. We aimed to evaluate the predictive ability of FSI for CV risk using a large-scale population dataset from the Korean National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS).MethodsAmong 514,866 individuals in the NHIS–HEALS, we excluded those who died, had a history of admission due to a CV event, and were heavy drinkers. The final study cohort comprised 283,427 participants. We employed both unadjusted and covariate-adjusted models in Cox proportional hazards regression analyses to determine the association between FSI and major adverse cardiovascular events (MACEs), CV events, and CV mortality.ResultsDuring a median follow-up of 5.9 years, we documented 9,674, 8,798, and 1,602 cases of MACEs, CV events, and CV mortality, respectively. The incidence of MACEs was 1.28%, 2.99%, 3.94%, and 4.82% in the first to fourth quartiles of FSI, respectively. The adjusted hazard ratios (95% confidence interval) for MACEs gradually and significantly increased with the FSI quartiles [1.302 (1.215–1.395) in Q2, 1.487 (1.390–1.590) in Q3, and 1.792 (1.680–1.911) in Q4], following an adjustment for conventional CV risk factors, including age, sex, smoking, drinking, physical activities, low-density lipoprotein cholesterol, estimated glomerular filtration rate, and waist circumference. Participants in the higher quartiles of FSI exhibited a noteworthy increase in the occurrence of CV event. However, upon adjusting for relevant risk factors, the association between FSI and CV mortality did not reach statistical significance.ConclusionOur study suggests that the FSI, which is a surrogate marker of NAFLD, has a prognostic value for detecting individuals at higher risk of CV events.

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“…NAFLD was defined as an FSI ≥23 [ 18 ], and this diagnostic model has been externally validated in several independent cohorts including Korean patients [ 18 , 19 , 20 ].…”

Section: Methodsmentioning

confidence: 99%

Protective Effect of Leisure-Time Physical Activity and Resistance Training on Nonalcoholic Fatty Liver Disease: A Nationwide Cross-Sectional Study

Park

Lim

Park

2022

IJERPH

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Background: Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease. The present study aimed to investigate the association of NAFLD with leisure-time physical activity (PA) levels and resistance training (RT). Methods: We used data from large nationwide cohorts in Korea. NAFLD was defined based on the Framingham steatosis index. Participants were categorized into four groups based on RT frequency and adherence to PA guidelines (≥150 min/week of moderate-intensity PA): Low-PA, Low-PA+RT, High-PA, and High-PA+RT. Multiple logistic regression models were used to assess the risk of NAFLD according to leisure-time PA levels and regularity of RT. Results: When compared with Low-PA, High-PA decreased the risk of NAFLD by 17%, and High-PA+RT further decreased the risk by 30%. However, the additional reduction in risk associated with the addition of RT was observed in men (19%), but not in women. In the High-PA group, men had a significantly higher training frequency and period for RT than women. Conclusions: Following the PA guideline may confer protective effects against NAFLD, while adding RT to High-PA can further decrease the risk of NAFLD. Sex-based differences in NAFLD risk in the High-PA+RT group may be due to the differences in the frequency and period of RT.

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The Ability of the Framingham Steatosis Index (FSI) to Predict Non-alcoholic Fatty Liver Disease (NAFLD): A Cohort Study

Cited by 10 publications

References 27 publications

Four hepatic steatosis indices in predicting quantitative computed tomography-based metabolic dysfunction-associated fatty liver disease

Four hepatic steatosis indices in predicting quantitative computed tomography-based metabolic dysfunction-associated fatty liver disease

Predictive value of the Framingham steatosis index for cardiovascular risk: a nationwide population-based cohort study

Protective Effect of Leisure-Time Physical Activity and Resistance Training on Nonalcoholic Fatty Liver Disease: A Nationwide Cross-Sectional Study

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