Reproduced from Medscape Medical News 2006. © 2006
Simple Index Helps Identify Fatty Liver
Alison Palkhivala
May 5, 2006 (Vienna) — A score derived from 5 easy-to-measure parameters can be used clinically to help identify patients with fatty liver disease, according to Italian researchers. The tool should help general practitioners and other physicians diagnose this underreported condition, which otherwise requires ultrasound for its identification.
According to senior investigator Giorgio Bedogni, MD, "Fatty liver is the most [common] liver disease in Western countries" and is often seen in combination with metabolic syndrome. "A diagnostic algorithm developed in the general population may help general practitioners to diagnose [it]." Dr. Bedogni is an internist and coordinator of the Clinical Epidemiology Unit at the Liver Research Center, University of Trieste, Italy. He is also an adjunct professor of statistics in medicine at the School of Nephrology & Dialysis, Modena and Reggio Emilia University, Italy.
Elisabetta Bugianesi, MD, PhD, who was not involved in the study, agrees that nonalcoholic fatty liver disease (NAFLD) in particular is an important clinical entity that can be difficult to identify. "NAFLD constitutes a special challenge for physicians for several reasons: any distinction between nonprogressive (fatty liver) and progressive disease (nonalcoholic steatohepatitis [NASH]) is only based on liver histology, but NAFLD patients are generally asymptomatic [so] invasive procedures are not easy to propose [or] to accept," she told Medscape via email.
"Surrogate markers (mainly alanine aminotransferase) are not universally accepted, and a large body of evidence indicates that progressive liver disease may also be present in subjects with normal enzyme levels," Dr. Bugianesi pointed out. "Hence, identification of scientifically compelling noninvasive markers is eagerly awaited." Long-term complications of NAFLD include cirrhosis and hepatocellular carcinoma. Dr. Bugianesi is a professor of gastroenterology and an expert in NAFLD from the Division of Gastro-hepatology, University of Torino, Italy.
In an effort to develop a simple method for identifying patients who may have fatty liver disease, Dr. Bedogni and colleagues used data from the Dionysos Nutrition and Liver Study to determine the degree to which drinking habits, anthropometry, and metabolic parameters contribute to the risk for the condition in 216 patients with suspected liver disease but no hepatitis B and C infection as well as in 280 age- and sex-matched controls. All participants were from the same town in northern Italy. The presence of fatty liver disease was confirmed via ultrasonography. Results were presented here by Vittorio di Maso, MD, another researcher at the Liver Research Center, at the 41st annual meeting of the European Association for the Study of the Liver (EASL).
"Body mass index and waist circumference are independent predictors of fatty liver in the general population, while ethanol intake and alanine transaminase [levels] are not," Dr. Bedogni told Medscape in an email. "A [Fatty Liver Index or FLI] score obtained from 5 parameters — gender, gamma-glutamyl-transferase, body mass index, waist circumference, and triglycerides — may be used to rule out fatty liver when 1.0 [or less, negative likelihood ratio = 0.2] and rule it in when [the score is at least] 3.0 [positive likelihood ratio = 4.4].... This score was developed on a representative sample of the general population of a town of Northern Italy and as such is ideal for use by general practitioners."
The authors conclude that patients' FLI could be used to determine who requires a confirmatory ultrasound and/or counseling to reduce weight or improve other clinical risk factors for complications.
According to Dr. Bugianesi, "This index may help primary care physicians to identify NAFLD, especially in high-risk subjects, and may help to increase the public awareness of NAFLD." Its only major limitation is that it cannot determine the type of fatty liver disease present. To date, she says, only liver biopsy can reliably do so.
EASL 2006: Abstract 676. Presented April 27, 2006.
Reviewed by Maria L. Gaiso, PhD
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