Clinical Trial

. 2015 Mar 17;10(3):e0120443.

doi: 10.1371/journal.pone.0120443. eCollection 2015.

External validation of fatty liver index for identifying ultrasonographic fatty liver in a large-scale cross-sectional study in Taiwan

Bi-Ling Yang¹, Wen-Chieh Wu², Kuan-Chieh Fang³, Yuan-Chen Wang⁴, Teh-Ia Huo⁵, Yi-Hsiang Huang⁶, Hwai-I Yang⁷, Chien-Wei Su⁸, Han-Chieh Lin⁸, Fa-Yauh Lee⁸, Jaw-Ching Wu⁹, Shou-Dong Lee¹⁰

Affiliations

¹ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.
² Division of Gastroenterology, Department of Medicine, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
³ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Healthcare Center, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
⁶ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁷ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
⁸ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁹ Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

PMID: 25781622
PMCID: PMC4363626
DOI: 10.1371/journal.pone.0120443

Clinical Trial

External validation of fatty liver index for identifying ultrasonographic fatty liver in a large-scale cross-sectional study in Taiwan

Bi-Ling Yang et al. PLoS One. 2015.

. 2015 Mar 17;10(3):e0120443.

doi: 10.1371/journal.pone.0120443. eCollection 2015.

Authors

Affiliations

¹ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.
² Division of Gastroenterology, Department of Medicine, Ren-Ai Branch, Taipei City Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
³ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Healthcare Center, Taipei Veterans General Hospital, Taipei, Taiwan.
⁵ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
⁶ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁷ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
⁸ Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁹ Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

PMID: 25781622
PMCID: PMC4363626
DOI: 10.1371/journal.pone.0120443

Abstract

Background and aims: The fatty liver index (FLI) is an algorithm involving the waist circumference, body mass index, and serum levels of triglyceride and gamma-glutamyl transferase to identify fatty liver. Although some studies have attempted to validate the FLI, few studies have been conducted for external validation among Asians. We attempted to validate FLI to predict ultrasonographic fatty liver in Taiwanese subjects.

Methods: We enrolled consecutive subjects who received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009. Ultrasonography was applied to diagnose fatty liver. The ability of the FLI to detect ultrasonographic fatty liver was assessed by analyzing the area under the receiver operating characteristic (AUROC) curve.

Results: Among the 29,797 subjects enrolled in this study, fatty liver was diagnosed in 44.5% of the population. Subjects with ultrasonographic fatty liver had a significantly higher FLI than those without fatty liver by multivariate analysis (odds ratio 1.045; 95% confidence interval, CI 1.044-1.047, p< 0.001). Moreover, FLI had the best discriminative ability to identify patients with ultrasonographic fatty liver (AUROC: 0.827, 95% confidence interval, 0.822-0.831). An FLI < 25 (negative likelihood ratio (LR-) 0.32) for males and <10 (LR- 0.26) for females rule out ultrasonographic fatty liver. Moreover, an FLI ≥ 35 (positive likelihood ratio (LR+) 3.12) for males and ≥ 20 (LR+ 4.43) for females rule in ultrasonographic fatty liver.

Conclusions: FLI could accurately identify ultrasonographic fatty liver in a large-scale population in Taiwan but with lower cut-off value than the Western population. Meanwhile the cut-off value was lower in females than in males.

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Conflict of interest statement

Competing Interests: One or more of the authors (including the corresponding author) currently serve, or have previously served, as an Academic Editor or Guest Editor for this journal; current academic editors of PLOS ONE: Chien-Wei Su, Teh-Ia Huo, Yi-Hsiang Huang, and Han-Chieh Lin. This does not alter the authors' adherence to PLOS ONE Editorial policies and criteria.

Figures

**Fig 1. Comparison of the prevalence rate of ultrasonogrphic fatty liver between male and female subjects.**
**(A)** Comparison of ultrasonogrphic fatty liver prevalence rate between male and female subjects stratified by age. **(B)** Comparison of ultrasonogrphic fatty liver prevalence rate between male and female subjects stratified by body mass index.

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External validation of fatty liver index for identifying ultrasonographic fatty liver in a large-scale cross-sectional study in Taiwan

Affiliations

External validation of fatty liver index for identifying ultrasonographic fatty liver in a large-scale cross-sectional study in Taiwan

Authors

Affiliations

Abstract

Conflict of interest statement

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