An observational study of the evaluation of fatty liver in non-alcoholics with metabolic syndrome using fatty liver index and its correlation with USG elastography

Background: NAFLD (Non Alcoholic Fatty Liver Disease) is being considered the hepatic component of metabolic syndrome. It is now the most common cause of chronic liver disease worldwide and needs to be addressed urgently as it is asymptomatic and widely prevalent and can progress to cirrhosis and hepatocellular carcinoma. There is a need for simpler methods to diagnose the condition in modern day practice which will help in identifying vulnerable subjects and in bringing about awareness and lifestyle modifications focused on reversal of the condition. Aim of this study was to check the applicability of the fatty liver index in modern day out patient practice using formula based FLI calculator.Methods: It was a cross sectional study on patients with metabolic syndrome in a tertiary care hospital. 60 patients with metabolic syndrome, both male and female above the age of 30 years and who were non-alcoholics were enrolled in the study. BMI, waist circumference, lipid profile and GGT were obtained and FLI calculated. It was compared with the ultrasound and Elastography reports. Chi square test, Independent t test and ANOVA test were used for comparing parameters. A p value of <0.05 was considered statistically significant.Results: Among 60 patients all had fatty liver which emphasizes that fatty liver is the hepatic component of metabolic syndrome. There is a significant correlation between BMI (Body Mass Index) and waist circumference in predicting fatty liver and to some extent its grade. Patients with higher BMI had a greater grade of fatty liver.Conclusions: The fatty liver index is a reliable predictor of fatty liver in people with metabolic syndrome. The grade of fatty liver increases with increase in waist circumference and increased BMI. Ultrasound and Elastography are reliable non invasive methods of detecting fatty liver. BMI and Waist circumference are strong predictive factors for fatty liver.

Validation of fatty liver index and hepatic steatosis index for screening of non-alcoholic fatty liver disease in adults with obstructive sleep apnea hypopnea syndrome / 中华医学杂志(英文版)

Background@#Obstructive sleep apnea hypopnea syndrome (OSAHS) is a contributing factor for non-alcoholic fatty liver disease (NAFLD). Non-invasive algorithms including fatty liver index (FLI) and hepatic steatosis index (HSI) have been used as a screening test for NAFLD in epidemiologic studies. The aim of this study is to compare the diagnostic accuracy of FLI and HSI for NAFLD detection in adults with OSAHS.@*Methods@#We enrolled consecutive adult subjects who were newly diagnosed with OSAHS from March 2016 to January 2018. NAFLD was diagnosed by ultrasonography. The accuracy and cut-off point of the FLI and HSI to detect NAFLD were assessed by analyzing the area under the receiver operating characteristic (AUROC) curve and the maximum Youden index analysis, respectively.@*Results@#The 326 subjects were diagnosed as NAFLD according to ultrasound findings, while 105 subjects who had normal abdominal ultrasonography were grouped as controls. Both FLI and HSI values were significantly higher in patients with NAFLD compared with controls. The AUROC of FLI and HSI for predicting NAFLD was 0.802 (95% confidence interval [CI] 0.762-0.839) and 0.753 (95% CI 0.710-0.793), respectively. The AUROC of FLI was significantly higher than that of HSI (P = 0.0383). The optimal cut-off value of FLI and HSI was 60 (sensitivity 66% and specificity 80%) and 35 (sensitivity 81% and specificity 60%), respectively.@*Conclusions@#Both FLI and HSI can serve as screening tools for NAFLD in OSAHS adults. The FLI shows better performance in diagnosing NAFLD than HSI.@*Trial registration@#Chinese Clinical Trial Registry (No. ChiCTR-OOB-15007253), http://www.chictr.org.cn/showproj.aspx?proj=11606.

Non-Alcoholic Fatty Liver Disease and Its Association with Depression in Korean General Population

BACKGROUND: Recent studies have indicated the significant association between non-alcoholic fatty liver disease (NAFLD) and depression. However, there is ongoing debate on whether the risk for depression is actually related with the presence and severity of NAFLD. Thus, this study was conducted to investigate the association between depression and NAFLD evaluated by diverse modalities. METHODS: A total of 112,797 participants from the Korean general population were enrolled. The study participants were categorized into three groups according to degree of NAFLD evaluated by ultrasonography, fatty liver index (FLI) and fibrosis-4 score (FIB-4). Depression was defined as a score of Center for Epidemiological Studies-Depression (CES-D) ≥ 16, and the odd ratios (ORs) and 95% confidence interval (CI) for depression (adjusted ORs [95% CI]) were assessed by multiple logistic regression analyses. RESULTS: In the unadjusted model, the presence and severity of NAFLD was not significantly associated with depressive symptoms. However, in the fully adjusted model, ORs for depression increased in proportion to the degree of ultrasonographically detected NAFLD (mild fatty liver: 1.14 [1.06–1.22]; and moderate to severe fatty liver: 1.32 [1.17–1.48]). An association was also observed between depression and FLI (30 ≤ FLI < 60: 1.06 [0.98–1.15]; FLI ≥ 60: 1.15 [1.02–1.29]). CONCLUSION: The presence and severity of NAFLD is significantly associated with depressive symptoms. In addition, this association was more distinct after adjusting for covariates including age, gender and insulin resistance. This finding indicates the necessity of further study evaluating the incidental relationship of depression with NAFLD.

The Role of Skeletal Muscle in Development of Nonalcoholic Fatty Liver Disease

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is closely correlated with abnormal accumulation of visceral fat, but the role of skeletal muscle remains unclear. The aim of this study was to elucidate the role of skeletal muscle in development of NAFLD. METHODS: Among 11,116 subjects (6,242 males), we examined the effects of skeletal muscle mass and visceral fat area (VFA, by bioelectric impedance analysis) on NAFLD using by the fatty liver index (FLI). RESULTS: Of the total subjects (9,565 total, 5,293 males) included, 1,848 were classified as having NALFD (FLI > or =60). Body mass index, lipid profile, fasting plasma glucose, hemoglobin A1c, prevalence of type 2 diabetes (DM), hypertension (HTN), and metabolic syndrome were higher in males than females, but FLI showed no significant difference. The low FLI group showed the lowest VFA and highest skeletal muscle mass of all the groups. Skeletal muscle to visceral fat ratio (SVR) and skeletal muscle index had inverse correlations with FLI, when adjusted for age and gender. In multivariate regression analysis, SVR was negatively associated with FLI. Among SVR quartiles, the highest quartile showed very low risk of NAFLD when adjusted for age, gender, lipid profile, DM, HTN, and high sensitivity C-reactive protein from the lowest quartiles (odds ratio, 0.037; 95% confidence interval, 0.029 to 0.049). CONCLUSION: Skeletal muscle mass was inversely associated with visceral fat area, and higher skeletal muscle mass may have a beneficial effect in preventing NAFLD. These results suggest that further studies are needed to ameliorate or slow the progression of sarcopenia.