Fatty Liver Index (FLI) Identifies Not Only Individuals with Liver Steatosis but Also at High Cardiometabolic Risk - PubMed (original) (raw)
Fatty Liver Index (FLI) Identifies Not Only Individuals with Liver Steatosis but Also at High Cardiometabolic Risk
Fabrizia Carli et al. Int J Mol Sci. 2023.
Abstract
A fatty liver index (FLI) greater than sixty (FLI ≥ 60) is an established score for metabolic dysfunction-associated steatotic liver disease (MASLD), which carries a high risk for diabetes and cardiovascular disease, while a FLI ≤ 20 rules out the presence of steatosis. Thus, we investigated whether FLI was associated with cardiometabolic risk factors, i.e., visceral (VAT), subcutaneous (SC), epicardial (EPI), extrapericardial (PERI), and total cardiac (CARD-AT) adipose tissue, hepatic fat ((by magnetic resonance imaging, MRI, and spectroscopy, MRS), and insulin resistance (IR, HOMA-IR and OGIS-index), and components of metabolic syndrome. All individuals with FLI ≥ 60 had MASLD, while none with FLI ≤ 20 had steatosis (by MRS). Subjects with FLI ≥ 60 had a higher BMI and visceral and cardiac fat (VAT > 1.7 kg, CARD-AT > 0.2 kg). FLI was positively associated with increased cardiac and visceral fat and components of metabolic syndrome. FLI, VAT, and CARD-AT were all associated with IR, increased blood pressure, cholesterol, and reduced HDL. For FLI ≥ 60, the cut-off values for fat depots and laboratory measures were estimated. In conclusion, FLI ≥ 60 identified not only subjects with steatosis but also those with IR, abdominal and cardiac fat accumulation, increased blood pressure, and hyperlipidemia, i.e., those at higher risk of cardiometabolic diseases. Targeted reduction of FLI components would help reduce cardiometabolic risk.
Keywords: MASLD; cardiac fat; cardiometabolic risk; epicardial fat; insulin resistance; metabolic syndrome; visceral fat.
Conflict of interest statement
The authors declare no conflict of interest.
Figures
Figure 1
Relationship (beta regression with logit link) between the MRS liver fat fraction and fatty liver index (solid red line) in a subgroup of 33 subjects (blue dots). A cut off of IHTG > 5% (horizontal dashed line) was used to diagnose hepatic steatosis. Vertical dashed lines indicate fatty liver index (FLI) cut off of 20 and 60.
Figure 2
Relationship between fat depots and fatty liver index. OLS regression plots the association between FLI and various fat depots. Top: total cardiac fat (A), i.e., the sum of extra-pericardial (B) and epicardial (C) adipose tissue; bottom: visceral (D) and subcutaneous (E).
Figure 3
Relationship between fatty liver index and components of insulin resistance, HOMA-IR (A) and OGIS (B) or of the metabolic syndrome, i.e., systolic (C) and diastolic (D) blood pressure, HDL (E), and total cholesterol (F). OLS regression plots the association between the selected laboratory measures and FLI.
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