FLI on the Wall

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries (1). A condition that is strongly associated with progressive hepatic disease, cardiometabolic disorders, and chronic kidney disease, it’s thought to affect more than 30 percent of adults in the industrialized population, and this prevalence skyrockets to 70 percent in the morbidly obese and those with type-2 diabetes (2).

In spite of the morbidity that NAFLD inflicts, liver biopsy remains the current gold standard for its diagnosis which, unarguably, is far from ideal. In order to trim the fat and find a simpler surrogate, a group of investigators analyzed four different diagnostic markers to find a noninvasive alternative – which they identified as the widely used fatty liver index (FLI) (2). Although it was the strongest candidate in their investigation, the researchers wanted to improve upon its power, which is when they turned to the blood-borne biomarkers plasma triglyceride, and glucose and lipid levels. In conjunction with FLI and a single nucleotide polymorphism from the PNPLA3 gene (the strongest determinant of NAFLD), they noted that the biomarkers could help calculate a more effective rubric for diagnosing NAFLD. The metric – dubbed “extended FLI” – considerably improved upon the strength of FLI to determine cases of NAFLD.

The investigators point out that there’s still a lot of work to be done in order to further validate extended FLI – considering that they mention their study population only included Caucasians at risk of type-2 diabetes. But they remain hopeful that, with further testing, the technique could become a widely-used method for detecting advanced stages of NAFLD, and could even turn out to be a good predictor of fibrosis as well.