ArticleThe American journal of gastroenterology2026
Poor Sensitivity of the Fatty Liver Index Among Lean Individuals.
Article in The American journal of gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Automated Deep Learning Detection of Hepatic Steatosis on Noncontrast Computed Tomography Scans and Discrepancy With Scan Reports.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Article
- Estimated Body Fat Percentage and Triglyceride-Glucose Index for Identifying MASLD in Lean Asian Adults: A Cross-Sectional Analysis.The Kaohsiung journal of medical sciences · 2026Article
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2 authors.
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Abstract
introductionFatty liver index (FLI) is widely used for detection of steatotic liver disease (SLD) in population studies. While frequently used to study SLD in lean individuals, its performance in this subgroup has not been validated. We hypothesized that FLI, which incorporates body-size measures, is not suitable for studies focusing on lean SLD.
methodsData from the National Health and Nutrition Examination Survey 2017-20 were used. Adults with available imaging and variables for FLI calculation were included. SLD was defined by controlled attenuation parameter ≥263 dB/m. Lean status was determined using ethnicity-adjusted body mass index cutoffs. The diagnostic performance of FLI was assessed overall and in lean participants using standard rule-in (≥60) and rule-out (<30) thresholds.
resultsThe study population included 7,191 individuals, of whom 3,602 (50%) had SLD. SLD was seen in 238 of 1,739 lean individuals (13.7%). While FLI had adequate performance in the overall population, it performed poorly in lean participants, in whom FLI ≥60 detected only 15 of 238 SLD cases (sensitivity 6.3%, positive predictive value 46%) with only modest improvement using the rule-out threshold. Lean individuals predicted to have SLD by FLI markedly differed from imaging-confirmed lean SLD; they were older and had higher body mass index, waist circumference, gamma-glutamyl transferase, and triglyceride levels and a greater burden of cardiometabolic comorbidities. DISCUSSION: With its inherent dependence on body-size measures, FLI does not identify lean SLD accurately. Moreover, applying FLI to lean individuals overestimates disease severity. The misclassification and misrepresentation biases imply that FLI should not be used in population-based studies of lean SLD.
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