The association between fatty liver index and onset of diabetes: secondary analysis of a population-based cohort study

Abstract

Background According to research, the fatty liver index (FLI) is associated with diabetes. However, few studies have been conducted to investigate the relationship between FLI and diabetes risk from various perspectives. This study comprehensively investigated the relationship between FLI and incident diabetes in a large Japanese population. Methods This retrospective cohort study included 14,280 participants from Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables are FLI and risk of type 2 diabetes mellitus (T2DM), respectively. To examine the link between FLI and incident T2DM, Cox proportional-hazards regression was employed. In addition, we performed a number of sensitivity studies to guarantee the validity of the results. Moreover, we conducted subgroup analyses. Results After adjusting covariates, the results showed that FLI was positively associated with the risk of T2DM (HR = 1.019, 95%CI: 1.012, 1.025). Additionally, the sensitivity analysis showed how reliable the outcomes were. And a stronger association between FLI and incident T2DM was observed in the regular exercisers (HR = 1.036, 95%CI: 1.019–1.053, P < 0.0001) and the population without ethanol consumption (HR = 1.028, 95%CI: 1.017–1.039, P < 0.0001). Besides, receiver operating characteristic (ROC) curve analysis showed that FLI was better than waist circumference, triglycerides, body mass index, and gamma-glutamyl transferase in predicting incident T2DM. Conclusion FLI is positively associated with incident T2DM.

ZJU Index as a Predictive Tool for Diabetes Incidence: Insights from a Population-Based Cohort Study

“…15,16 A myriad of studies provide evidence that the severity of NAFLD, assessed by the FLI, predicts the development of diabetes. [17][18][19] However, the FLI was initially developed and validated in Western populations, raising concerns about its accuracy in assessing NAFLD among the Asian population. 20 A previous study conducted by our team revealed that the ZJU Index, which comprises four independent risk factors for NAFLD, namely, body mass index (BMI), fasting plasma glucose, triglyceride, and the alanine aminotransferase-to-aspartate aminotransferase ratio, and an adjustment point for females, is a superior predictor of NAFLD in the Chinese population compared to the FLI.…”

“…31 To determine the presence of NAFLD in the Chinese population, our team developed the "ZJU Index" in 2015, with the aim of providing an alternative to ultrasonography and screening patients indicated for CT and MRI. 18 Compared with the Fatty Liver Index (FLI), the ZJU Index offers a comparable level of simplicity, as all its components are easily accessible, and it outperforms the FLI in predicting NAFLD incidence. The exclusion of waist circumference from the ZJU Index has been demonstrated to contribute to its independence across different races and ethnicities, 32,33 whereas the addition of fasting plasma glucose values to the model fosters a closer relationship between NAFLD and T2DM.…”