New Index Generated for Diagnosing Non-Alcoholic Fatty Liver Disease

Based on clinical data, researchers have generated a new fatty liver index (FLI) that can predict the presence of fatty liver disease (FLD) with high accuracy, enabling development of an extended, more effective diagnostic index for nonalcoholic fatty liver disease (NA-FLD), which has become an epidemic in industrialized countries.

There is not only a great interest worldwide to understand the causes and consequences of FLD, but also to diagnose it at an early stage. Under the direction of Professor Norbert Stefan, researchers of the Department of Internal Medicine IV of Tübingen University Hospital and the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Zentrum München as well as of the German Institute for Nutrition and Health (DIfE), both partners of the German Center for Diabetes Research, succeeded in improving on the current diagnostic index.


Approximately every third adult in the industrialized countries has a morbidly fatty liver. For these people, this not only increases the risk of advanced liver diseases such as liver cirrhosis and liver cancer, but also in particular type 2 diabetes and cardiovascular diseases. To be able to intervene early with preventive and therapeutic measures, the fatty liver must be detected in time. The ultrasound liver examination and the determination of the liver values are suitable, but in most cases they can only diagnose the fatty liver in an advanced stage. More sophisticated tests such as magnetic resonance spectroscopy are more meaningful, but they are not widely applicable because of the relatively high costs in clinical practice.

Therefore, scientists are working on simple accurate diagnostic methods that would be more suitable. Among various indices that have been developed, the Fatty Liver Index (FLI) consisting of the parameters age, waist circumference, and triglyceride levels (TG) measured in the blood in a fasting state, and gamma-glutamyl transpeptidase (GGT), has been shown to be quite effective.

The researchers from Tübingen led by Prof. Stefan, in collaboration with Prof. Schulze of DIfE, and their colleagues from Hamburg and Italy, have developed an improved FLI. For this purpose, in addition to the parameters of the FLI, they used the TG and glucose levels from an oral glucose tolerance test measured at the time point of 2 hours, as well as the most important gene variant for fatty liver (rs738409 C>G in PNPLA3). On the basis of data from the TULIP (Tübingen Lifestyle Intervention Program) study, they were able to show that with this new, extended FLI, not only can the fatty liver be diagnosed better than with the known FLI, but also the probability of reducing liver fat content during a lifestyle intervention can be more precisely determine.

We hope that “this index will be increasingly used in clinical practice to diagnose fatty liver disease at an early stage in order to prevent the consequences of fatty liver disease,” said Prof. Stefan.

The study, by Kantartzis K et al, was published online January 14, 2017, in the journal Diabetes & Metabolism.