The Role of the Fatty Liver Index (FLI) in the Management of Non-Alcoholic Fatty Liver Disease: A Systematic Review

Biciusca, Teodora; Stan, Sorina Ionelia; Balteanu, Mara Amalia; Cioboata, Ramona; Ghenea, Alice Elena; Danoiu, Suzana; Bumbea, Ana-Maria; Biciusca, Viorel

doi:10.3390/diagnostics13213316

Cited by 3 publications

References 125 publications

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Fatty liver index as an independent predictor of all-cause and disease-specific mortality

Zhang,

Ren,

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Purpose: This study aims to assess the prognostic value of the fatty liver index (FLI), a noninvasive tool for hepatic steatosis assessment, in predicting all-cause and disease-specific mortality. Methods: We linked data from the National Health and Nutrition Examination Survey III (1988–1994) with Public-Use Mortality Files, forming a cohort of 11 297 participants with a median follow-up period of 26.25 years. Cox proportional hazards models were used to evaluate the association between FLI and all-cause mortality, while Fine and Gray’s models assessed the relationship between FLI and disease-specific mortality. Results: The FLI ≥ 60 was independently associated with an increased risk of all-cause mortality (hazard ratio = 1.24, P < 0.001), as well as mortality from malignant neoplasms (hazard ratio = 1.18, P = 0.048), diabetes (hazard ratio = 2.62, P = 0.001), and cardiovascular diseases (CVDs) (hazard ratio = 1.18, P = 0.018), compared to FLI < 30. No significant associations were found with Alzheimer’s disease, influenza and pneumonia, chronic lower respiratory diseases, or renal disorders. Subgroup analyses indicated that individuals who were females aged 40–60 (hazard ratio = 1.67, P = 0.003), non-overweight (hazard ratio = 1.75, P = 0.007), or without abdominal obesity (hazard ratio = 1.75, P = 0.007) exhibited a stronger association between FLI ≥ 60 and all-cause mortality. Conclusion: These findings support the prognostic value of the FLI for predicting mortality from all causes, malignant neoplasms, diabetes, and CVDs. Targeted attention is needed in postmenopausal women, non-overweight, and non-abdominally obese populations.

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Fatty liver index as an independent predictor of all-cause and disease-specific mortality

Zhang,

Ren,

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Fatty Liver Index (FLI) is the best score to predict MASLD with 50% lower cut-off value in women than in men

Crudele,

De Matteis,

Novielli

et al. 2024

Biol Sex Differ

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Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by the presence of hepatic steatosis, detected on ultrasonography (US) imaging or histology, and at least one of criteria for Metabolic Syndrome diagnosis. Simple non-invasive tests (NITs) have been proposed as an acceptable alternative when US and biopsy are not available or feasible but have not been validated for MASLD. In this observational study, we investigated the reliability of NITs for MASLD detection and whether sex-differences in screening methods should be considered. Methods We included 1069 individuals (48% males and 52% females) who underwent their first clinical examination for Metabolic Syndrome in the period between January 2015 and December 2022. Liver steatosis was detected through US and anthropometric and clinical parameters were recorded. Results Liver steatosis was detected in 648 patients and MASLD was diagnosed in 630 subjects (355 males; 275 females). Women with MASLD showed better metabolic profile and lower prevalence of Metabolic Syndrome criteria than men. Among NITs, Fatty Liver Index (FLI) showed the best ability for detection of MASLD, with a cut-off value of 44 (AUC = 0.82). When considering the two sexes for MASLD detection via FLI, despite no substantial differences regarding FLI correlations with metabolic biomarkers except for age, women showed marked lower FLI cut-off value (32; AUC = 0.80) than men (60; AUC = 0.80). Conclusions In this study, we found that FLI is the best non-invasive predictor of both liver steatosis and MASLD. The finding that in women FLI cut-off value for MASLD detection is 50% lower than in men suggests the need of a sex-specific personalized program of screening and prevention of dysmetabolism-related liver diseases, despite outwardly healthy biomarkers profile.

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Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Type 2 Diabetes: Risk of Heart Failure

Oh,

Kim,

Lee

et al. 2024

Preprint

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BACKGROUND & AIMS The association between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is unclear. This study aimed to investigate the impact of MASLD on the risk of heart failure and cardiovascular (CV) mortality in patients with T2DM. METHODS In a nationwide cohort study, 2,745,689 adults with T2DM were followed from 2009–2012 until 2018. Participants were categorized into no steatotic liver disease (no SLD) and SLD groups. The SLD group was stratified based on metabolic risk factors, alcohol consumption, and other liver diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for heart failure (HF) and cardiovascular mortality risk. RESULTS The prevalence of MASLD, metabolic alcohol-associated liver disease (MetALD), MASLD with other co-existing liver diseases (Other), and alcohol-associated liver disease with metabolic dysfunction (ALD with MD) was 48.3%, 7.1%, 4.6%, and 2.2%. Individuals with MASLD (adjusted HR [aHR], 1.11), MetALD (aHR, 1.14), ALD with MD (aHR, 1.32) and Other (aHR, 1.23) had a higher risk of developing HF compared with the no SLD group. The risk of CV mortality was increased in those with MASLD, MetALD, ALD with MD and Other compared to those with no SLD. The risk of new-onset HF and cardiovascular mortality showed a J-shaped association with alcohol consumption regardless of SLD status. CONCLUSION SLD is independent risk factor of new-onset heart failure and cardiovascular mortality in persons with T2DM, and alcohol consumption has a J-shaped association with risk of HF and CV mortality, regardless of SLD status.

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The Role of the Fatty Liver Index (FLI) in the Management of Non-Alcoholic Fatty Liver Disease: A Systematic Review

Cited by 3 publications

References 125 publications

Fatty liver index as an independent predictor of all-cause and disease-specific mortality

Fatty liver index as an independent predictor of all-cause and disease-specific mortality

Fatty Liver Index (FLI) is the best score to predict MASLD with 50% lower cut-off value in women than in men

Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Type 2 Diabetes: Risk of Heart Failure

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