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The Fatty Liver Index has limited utility for the detection and quantification of hepatic steatosis in obese patients

Hepatology International volume 7, pages 592–599 (2013)Cite this article

Abstract

Purpose

Noninvasive tools for the detection of hepatic steatosis are needed. The Fatty Liver Index (FLI), which includes body mass index (BMI), waist circumference, triglycerides, and γ-glutamyl-transferase, has been proposed as a screening tool for fatty liver. Our objective was to validate the FLI for the detection and quantification of hepatic steatosis in an obese population.

Methods

Patients with chronic liver disease and BMI ≥ 28 kg/m2 underwent liver biopsy and FLI determination. FLI performance for diagnosing steatosis compared with biopsy was assessed using areas under receiver operating characteristic curves (AUROCs), and a novel model for the prediction of significant steatosis (≥5 %) was derived.

Results

Among 250 included patients, 65 % were male, and the median BMI was 33 kg/m2; 48 % had nonalcoholic fatty liver disease, and 77 % had significant (≥5 %) steatosis. The FLI was weakly correlated with the percentage (ρ = 0.25, p = 0.0001) and grade of steatosis (ρ = 0.28, p < 0.00005). The median FLI was higher among patients with significant steatosis (91 vs. 80 with <5 % steatosis; p = 0.0001) and the AUROC for this outcome was 0.67 (95 % CI 0.59–0.76). At an optimal FLI cut-off of 79, the FLI was 81 % sensitive and 49 % specific, and had positive and negative predictive values of 84 and 43 %, respectively. A novel index including triglycerides, glucose, alkaline phosphatase, and BMI outperformed the FLI for predicting significant steatosis [AUROCs 0.78 vs. 0.68; p = 0.009 (n = 247)].

Conclusions

In obese patients, the FLI is a poor predictor of significant steatosis and has limited utility for steatosis quantification compared with liver histology. A novel index including triglycerides, glucose, alkaline phosphatase, and BMI may be useful, but requires validation.

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Acknowledgements

The authors thank Divine Tanyingoh for statistical assistance. This study was supported by Echosens (Paris, France). Dr. Myers is supported by grants from the Canadian Institutes of Health Research and Alberta Heritage Foundation for Medical Research (now Alberta Innovates, Health Solutions).

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Affiliations

  1. Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, 6D22, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Meredith A. Borman, Farah Ladak, Pam Crotty & Robert P. Myers

  2. Department of Pathology, Mt. Sinai Hospital, Toronto, ON, Canada

    Aaron Pollett & Richard Kirsch

  3. Liver Unit Centre Hospitalier de L’Université de Montréal, Hôpital Saint-Luc, Montréal, QC, Canada

    Gilles Pomier-Layrargues

  4. Multi-Organ Transplant Unit, University of Western Ontario, London, Canada

    Melanie Beaton

  5. Toronto Western Hospital Liver Centre, Toronto, Canada

    Andres Duarte-Rojo

  6. Toronto Liver Centre, Toronto, ON, Canada

    Magdy Elkashab

  7. Liver Unit, University of Calgary, 6D22, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2 N 4Z6, Canada

    Robert P. Myers

Authors
  1. Meredith A. Borman
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  2. Farah Ladak
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  3. Pam Crotty
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  4. Aaron Pollett
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  5. Richard Kirsch
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  6. Gilles Pomier-Layrargues
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  7. Melanie Beaton
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  8. Andres Duarte-Rojo
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  9. Magdy Elkashab
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  10. Robert P. Myers
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Correspondence to Robert P. Myers.

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Borman, M.A., Ladak, F., Crotty, P. et al. The Fatty Liver Index has limited utility for the detection and quantification of hepatic steatosis in obese patients. Hepatol Int 7, 592–599 (2013). https://doi.org/10.1007/s12072-012-9401-4

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  • DOI: https://doi.org/10.1007/s12072-012-9401-4

Keywords

  • Biopsy
  • Fatty liver
  • Fibrosis
  • Noninvasive
  • Steatosis