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External Validation of the Fatty Liver Index for Identifying Nonalcoholic Fatty Liver Disease in a Population-based Study

https://doi.org/10.1016/j.cgh.2012.12.031Get rights and content

Background & Aims

We aimed to validate the fatty liver index (FLI), an algorithm that is based on waist circumference, body mass index, and levels of triglyceride and γ-glutamyltransferase. We calculated its ability to identify fatty liver disease from any cause or nonalcoholic fatty liver disease (NAFLD) in a large population of white elderly persons.

Methods

We collected ultrasonography and FLI data from participants of the Rotterdam Study from February 2009 to February 2012; 2652 subjects (mean age, 76.3 ± 6.0 years) were interviewed and received a clinical examination that included abdominal ultrasound, analysis of blood samples during fasting, and anthropometric assessment. The ability of the FLI to detect (nonalcoholic) fatty liver was assessed by using area under the receiver operator characteristic (AUROC) curve analysis.

Results

FLI score was associated with NAFLD in multivariable analysis (odds ratio, 1.05; 95% confidence interval [CI], 1.04–1.05; P < .001). FLI identified patients with NAFLD with an AUROC curve of 0.813 (95% CI, 0.797–0.830) and those with fatty liver from any cause with an AUROC curve of 0.807 (95% CI, 0.792–0.823).

Conclusions

The FLI (an algorithm that is based on waist circumference, body mass index, and levels of triglyceride and γ-glutamyltransferase) accurately identifies NAFLD, confirmed via ultrasonography, in a large, white, elderly population.

Section snippets

Study Population

We analyzed data from the Rotterdam Study, a large, prospective, population-based cohort study conducted among elderly inhabitants of a district of Rotterdam, The Netherlands. The rationale and study design have been described previously.9 The medical ethics committee at the Erasmus University of Rotterdam approved the study, and written informed consent was obtained from all participants.

Abdominal ultrasonography was performed in the first 2 cohorts of the Rotterdam Study between February 2009

Results

FLI could be calculated in 3034 of 3205 elderly participants in whom liver ultrasonography was performed. In total, 382 participants were excluded for possible secondary causes of fatty liver (excessive alcohol consumption [n = 251], positive hepatitis B surface antigen or anti–hepatitis C virus [n = 21], and use of pharmacologic agents associated with fatty liver [n = 119]), leaving 2652 participants for analyses. General characteristics of the study population are shown in Table 1. Sixty

Discussion

In the present study we validated the FLI in 2652 elderly participants of the population-based Rotterdam Study. We demonstrated that FLI has good predictive values in elderly people for both ultrasonographically diagnosed fatty liver that is due to any cause as well as nonalcoholic fatty liver in this population, independent of age.

Sensitivity and specificity for fatty liver at the recommended cutoff of 60 (to rule in fatty liver) in the original study were 61% and 86%, respectively, and 62%

Acknowledgments

The authors thank the Rotterdam Study participants and Rotterdam Study team; in particular, they thank participating general practitioners and pharmacists.

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Conflicts of interest The authors disclose no conflicts.

Funding The Rotterdam Study is supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Scientific Research (NWO); the Netherlands Organization for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the inistry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam.

This study was financially supported by the Foundation for Liver Research (SLO), Rotterdam, The Netherlands.

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