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Certainly, the information about non-alcoholic fatty liver disease (NAFLD) provided by the authors can only be agreed with (1). Nevertheless, I think that the “Fatty Liver Index“ (FLI), a validated non-invasive diagnostic tool, should also be mentioned as a relevant aid to decision-making in everyday clinical practice. Developed by the working group around Giorgio Bedogni in 2006, the FLI is calculated using an algorithm based on body-mass index, waist circumference, triglycerides, and gamma-glutamyl transferase. An FLI higher than 60 indicates a more than 80% likelihood of hepatic steatosis (2, 3). Implementing the easy-to-use FLI as part of a tight patient monitoring regimen could offer clinical advantages as patients with an FLI above 60 also have an increased incidence of diabetes, develop early atherosclerosis (thicker intima/media, higher plaque burden) and show an increased mortality compared with patients with low FLIs.

As a nutritional scientist, I like to point out with regard to the alimentary management of the disease—which plays a critical role in NAFLD patients—that only the Mediterranean diet is supported by some potential evidence (4): plenty of vegetables, fruits, legumes, mainly complex carbohydrates with low glycemic index, fish, olive oil, dairy products, etc. and little processed food, “red meat“, sweets and sugary soft drinks would thus be the primary long-term diet for NAFLD patients.

DOI: 10.3238/arztebl.2015.0143b

Dr. oec. troph. Martin Hofmeister

Verbraucherzentrale Bayern e. V., Referat Lebensmittel und Ernährung,
München

hofmeister@vzbayern.de

Conflict of interest statement
The author declares that no conflict of interest exists.

1.
Weiß J, Rau M, Geier A: Non-alcoholic fatty liver disease: epidemiology, clincal course, investigation and treatment. Dtsch Arztebl Int 2014; 111: 447–52. VOLLTEXT
2.
Bedogni G, Bellentani S, Miglioli L, et al.: The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006; 6: 33. CrossRef MEDLINE PubMed Central
3.
Koehler EM, Schouten JN, Hansen BE, et al.: External validation of the fatty liver index for identifying nonalcoholic fatty liver disease in a population-based study. Clin Gastroenterol Hepatol 2013; 11: 1201–4. CrossRef MEDLINE
4.
Sofi F, Casini A: Mediterranean diet and non-alcoholic fatty liver disease: New therapeutic option around the corner? World J Gastroenterol 2014; 20: 7339–46. CrossRef MEDLINE PubMed Central
1.Weiß J, Rau M, Geier A: Non-alcoholic fatty liver disease: epidemiology, clincal course, investigation and treatment. Dtsch Arztebl Int 2014; 111: 447–52. VOLLTEXT
2.Bedogni G, Bellentani S, Miglioli L, et al.: The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 2006; 6: 33. CrossRef MEDLINE PubMed Central
3.Koehler EM, Schouten JN, Hansen BE, et al.: External validation of the fatty liver index for identifying nonalcoholic fatty liver disease in a population-based study. Clin Gastroenterol Hepatol 2013; 11: 1201–4. CrossRef MEDLINE
4.Sofi F, Casini A: Mediterranean diet and non-alcoholic fatty liver disease: New therapeutic option around the corner? World J Gastroenterol 2014; 20: 7339–46. CrossRef MEDLINE PubMed Central

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