A fatty liver index-based sequential strategy for identifying hepatic steatosis in individuals with suspected steatotic liver disease.
9 affiliations
- 1Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510000, Guangdong, China.
- 2Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, No.600 Tianhe Road, Tianhe District, Guangzhou, 510080, China.
- 3Department of Bariatric Surgery, The First Affiliated Hospital, Jinan University, No. 613 West Huangpu Avenue, Tianhe District, Guangzhou, 510080, China.
- 4Department of Geriatrics, Guangdong Provincial People's Hospital, No. 106 Zhongshan II Road, Yuexiu District, Guangzhou, 510000, Guangdong, China.
- 5Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510000, Guangdong, China.
- 6Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510000, Guangdong, China.
- 7Department of Clinical Laboratory, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, China. [email protected].
- 8Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510000, Guangdong, China. [email protected].
- 9Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan II Road, Yuexiu District, Guangzhou, 510000, Guangdong, China. [email protected].
Abstract
Objective
Fatty liver index (FLI) is widely used as a non-invasive tool for identifying hepatic steatosis but performs poorly in lean individuals and leaves a substantial proportion of individuals within an indeterminate range. This cross-sectional study evaluated whether combination strategies could improve identification of hepatic steatosis in a selected referred population with suspected steatotic liver disease (SLD).Methods
In a derivation cohort of 1648 subjects with suspected SLD who underwent MRI-PDFF assessment between January 2015 and January 2022, we evaluated five non-invasive indices (FLI, hepatic steatosis index [HSI], liver fat score [LFS], visceral adiposity index [VAI], and triglyceride-glucose index [TyG]). Four FLI-based sequential strategies were developed and further validated in an independent biopsy-based cohort of 426 patients from five tertiary centers in South China.Results
FLI performed best in identifying hepatic steatosis among the five non-invasive indices, with an AUROC of 0.75, but showed a high missed-identification rate exceeding 90% in individuals with BMI < 23 kg/m². In Strategy 4, the FLI-LFS sequential algorithm improved identification performance in lean individuals. In the derivation cohort, sensitivity increased from 9.4% to 78.6%, the missed-identification rate decreased from 90.6% to 21.4%, and accuracy increased from 30.0% to 73.1%. A similar improvement in missed identification was observed in the validation cohort.Conclusions
Compared with FLI alone, the sequential FLI-LFS algorithm substantially improved the identification of hepatic steatosis among lean individuals with suspected SLD. The strategy may help identify individuals who require further imaging and etiological evaluation but should not be regarded as a stand-alone tool for determining the subtype or cause of SLD.
Related
- Comparison of Metabolic Dysfunction‐Associated Steatotic Liver Disease Between Individuals With Werner Syndrome and Those With Insulin‐Resistant Type 2 Diabetes: Hepatic Steatosis and Fibrosis Indices
- The CYB5R3–mARC1 Redox Axis in Metabolic Dysfunction-associated Steatotic Liver Disease: Mechanistic Basis and Therapeutic Prospects across the Steatosis–Cirrhosis–Hepatocellular Carcinoma Spectrum
- Very low-calorie diet reduces hepatic steatosis and remodels circulating metabolite-microRNAs networks in metabolic dysfunction-associated steatotic liver disease: A pilot study
- Comparative Efficacy and Safety of Saroglitazar and Dapagliflozin on Hepatic Steatosis and Glycemic Control in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: A 25-Week Prospective Multicenter Comparative Cohort Study.
- Hepatic steatosis and diabetic retinopathy in individuals with type 1 diabetes: a cross-sectional study using liver elastography
BibTeX
@article{yang2026fatty,
title = {{A fatty liver index-based sequential strategy for identifying hepatic steatosis in individuals with suspected steatotic liver disease.}},
author = {Yan Yang and Xiongcai Feng and Hong Deng and Zhiyong Dong and Lishu Xu and Shiting Feng and Bing Liao and Congxiang Shao and Pinning Feng and Bihui Zhong and Junzhao Ye},
journal = {BMC gastroenterology},
year = {2026},
month = aug,
doi = {10.1186/s12876-026-05173-x},
url = {https://europepmc.org/article/MED/42958515},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A fatty liver index-based sequential strategy for identifying hepatic steatosis in individuals with suspected steatotic liver disease.
AU - Yan Yang
AU - Xiongcai Feng
AU - Hong Deng
AU - Zhiyong Dong
AU - Lishu Xu
AU - Shiting Feng
AU - Bing Liao
AU - Congxiang Shao
AU - Pinning Feng
AU - Bihui Zhong
AU - Junzhao Ye
PY - 2026
DA - 2026/08/03
JO - BMC gastroenterology
DO - 10.1186/s12876-026-05173-x
UR - https://europepmc.org/article/MED/42958515
AB - Objective Fatty liver index (FLI) is widely used as a non-invasive tool for identifying hepatic steatosis but performs poorly in lean individuals and leaves a substantial proportion of individuals within an indeterminate range. This cross-sectional study evaluated whether combination strategies could improve identification of hepatic steatosis in a selected referred population with suspected steatotic liver disease (SLD).Methods In a derivation cohort of 1648 subjects with suspected SLD who underwent MRI-PDFF assessment between January 2015 and January 2022, we evaluated five non-invasive indices (FLI, hepatic steatosis index [HSI], liver fat score [LFS], visceral adiposity index [VAI], and triglyceride-glucose index [TyG]). Four FLI-based sequential strategies were developed and further validated in an independent biopsy-based cohort of 426 patients from five tertiary centers in South China.Results FLI performed best in identifying hepatic steatosis among the five non-invasive indices, with an AUROC of 0.75, but showed a high missed-identification rate exceeding 90% in individuals with BMI < 23 kg/m². In Strategy 4, the FLI-LFS sequential algorithm improved identification performance in lean individuals. In the derivation cohort, sensitivity increased from 9.4% to 78.6%, the missed-identification rate decreased from 90.6% to 21.4%, and accuracy increased from 30.0% to 73.1%. A similar improvement in missed identification was observed in the validation cohort.Conclusions Compared with FLI alone, the sequential FLI-LFS algorithm substantially improved the identification of hepatic steatosis among lean individuals with suspected SLD. The strategy may help identify individuals who require further imaging and etiological evaluation but should not be regarded as a stand-alone tool for determining the subtype or cause of SLD.
SN - 1471-230X
ER -