Benefit: “Therapeutic Indication“
Liver biopsy as the gold standard for diagnosis should only be performed if a therapeutic indication can be derived from it. Ultrasonography as a non-invasive screening method loses accuracy in early stages of the disease and depends very much on the skills and experiences of the examiner. Therefore, we prefer the ”Fatty Liver Index“ (FLI) for screening. In their publications (1, 2), Bedogni et al. described a simple and accurate indicator which calculates the FLI using an algorithm based on triglycerides (mg/dL), BMI (kg/m2), gamma-GT (U/L), and waist circumference (cm). The FLI can vary between 0 and 100. An FLI <30 (negative likelihood ratio = 0.2) rules out fatty liver with a high degree of certainty, while an FLI >60 (positive likelihood ratio = 4.3) rules in fatty liver.
The significance of the FLI was confirmed in subsequent studies. An FLI >60 is indicative of fatty liver with 78% probability, while an FLI of 20 or less rules out fatty liver with 91% probability.
Not only can the FLI be used for screening purposes, it is also an appropriate method for patient monitoring after dietary interventions. A multivariate adjusted analysis of data from more than 3000 patients undergoing coronary angiography (3) demonstrated for the group of patients with an FLI above 75.6 a highly statistically significant increase in cardiovascular mortality, non-cardiovascular mortality (infections, cancer, liver disease), and a significantly increased overall mortality.
Since “doctors in private practice have an important steering function“, the FLI is ideally suited for both screening and follow-up, as it is easy to use and cost-effective.
Dr. med. Hardy Walle
Bodymed AG, Kirkel
Conflict of interest statement
Dr. Walle is the CEO of the Bodymed AG and managing director of the Thanaka GmbH.
|1.||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|
|2.||Bedogni G, Kahn HS, Bellentani S, Tiribelli C: A simple index of lipid overaccumulation is a good marker of liver steatosis. BMC Gastroenterology 2010; 10: 98. CrossRef MEDLINE PubMed Central|
|3.||Lerchbaum E, Pilz S, Grammer TB, et al.: The fatty liver index is associated with increased mortality in subjects referred to coronary angiography; Nutrition, Metabolism & Cardiovascular Diseases 2013; 23: 1231–8. CrossRef MEDLINE|
|4.||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|