Fatty liver index may be a useful cardiometabolic risk factor

45th Annual Meeting of the European Association for the Study of Diabetes

High levels of fatty liver index (FLI) were associated with increased insulin resistance, carotid intima-media thickness and coronary heart disease risk in middle-aged people without diabetes, according to new data presented here.

Using data from the European RISC study (n=1,308), researchers in Italy evaluated a variety of cardiometabolic risk factors, including fatty liver index, metabolic profile, glucose tolerance, peripheral insulin sensitivity, hepatic insulin resistance, beta cell function, physical activity, CHD risk and early carotid atherosclerosis.

FLI is a new index recently proposed as a predictor of the presence of fatty liver, which includes in its formula waist circumference, BMI and triglycerides, Amalia Gastaldelli, PhD, metabolism unit, Fondazione Toscana G. Monasterio and CNR Institute of Clinical Physiology, Pisa, Italy, told Endocrine Today. FLI >60 is equal to a greater than 78% presence of fatty liver whereas FLI <20 is equal to a greater than 91% absence of fatty liver, she said.

The first goal was to validate FLI as a predictor of hepatic steatosis, and the second goal was to determine if FLI score >60 could predict metabolic alterations and presence of atherosclerosis. In a separate group of people (n=37), hepatic fat content was measured using magnetic resonance spectroscopy.

Comparison revealed that FLI and hepatic fat percentage were well correlated, according to the researchers. People with FLI <20 had no hepatic fat (range, 0.4% to 4.2%; n=6) whereas those with FLI >60 had steatosis (range, 8.6% to 24%; n=10).

In the RISC cohort, people with FLI scores >60 had higher fasting concentrations of glucose, insulin and LDL, and reduced concentrations of HDL, compared with those with index scores <20. Moreover, they had higher blood pressure, were more insulin resistant at the whole body level and in the liver, and had impaired beta cell glucose sensitivity, Gastaldelli said.

Overall, the RISC cohort was at low risk for CHD – 9% were at medium-to-high risk and 83% were at below average risk. The 10-year CHD score was positively associated with BMI and waist circumference, but negatively associated with physical activity and peripheral insulin sensitivity. The researchers reported a strong association between FLI and CHD.

Intima-media thickness was low, on average, in the cohort (0.60 mm), and was positively associated with age, BMI, waist circumference, systolic BP, LDL and fasting plasma glucose; it was negatively associated with HDL, physical activity, peripheral insulin sensitivity and FLI (P<.0001) for all. Higher values of intima-media thickness were also associated with increased CHD and fatty liver scores. Independent predictors of intima-media thickness included peripheral insulin sensitivity, age, systolic BP, LDL and gender, according to multivariate analysis. When FLI was added to the multivariate model, it replaced peripheral insulin resistance (P=.0001).

“Calculation of FLI from simple metabolic and anthropometric data can be a useful parameter to assess cardiometabolic risk,” Gastaldelli said. – by Katie Kalvaitis

For more information:

Gastaldelli A. OP 31 #182. Presented at: the 45th Annual Meeting of the European Association for the Study of Diabetes; Sept. 29-Oct. 2, 2009; Vienna.