Validity of fatty liver disease indices in the presence of alcohol consumption

Abstract

Background & aims

Non-alcoholic fatty liver disease (NAFLD) and alcohol-related liver disease frequently coexist. While several blood-based indices exist for the detection of NAFLD, few studies have examined how alcohol use possibly impacts their diagnostic performance. We analysed the effects of alcohol use on the performance of indices for detecting fatty liver disease (FLD).

Methods

We included participants from the Cardiovascular Risk in Young Finns Study (Finnish sample) and KORA study (German sample) who underwent abdominal ultrasound or magnetic resonance imaging, respectively, for detection of FLD and had serum analyses available for calculation of Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), Lipid Accumulation Product (LAP), and Dallas Steatosis Index (DSI). Alcohol use was estimated by questionnaires as mean daily consumption and binge drinking (Finnish sample only). Predictive performance for FLD was assessed according to alcohol consumption.

Results

The study included 1426 (Finnish sample) and 385 (German sample) individuals, of which 234 (16%) and 168 (44%) had FLD by imaging. When alcohol consumption was <50 g/day, all indices discriminated FLD with area under the receiver operating characteristics (AUROC) of 0.82–0.88. AUROCs were 0.61–0.66 among heavy drinkers (>50 g/day). AUROCs decreased to 0.74–0.80 in the highest binge-drinking category (>2 times/week). Alcohol use correlated with FLI and LAP (r-range 0.09–0.16, p-range <.001–.02) in both samples and with DSI (r = 0.13, p < .001) in the Finnish sample.

Conclusions

Indices perform well and comparably for detection of FLD with alcohol consumption <50 g/day and with different binge-drinking behaviour.

Keywords:

• Fatty liver index
• hepatic steatosis index
• lipid accumulation product
• Dallas steatosis index
• NAFLD

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The Young Finns Study has been financially supported by the following grants from the Academy of Finland: 322098, 286284, 134309 (Eye), 126925, 121584, 124282, 255381, 256474, 283115, 319060, 320297, 314389, 338395, 330809, 104821, 129378 (Salve), 117797 (Gendi), and 141071 (Skidi); the Social Insurance Institution of Finland; Competitive State Research Financing of the Expert Responsibility area of Kuopio, Tampere, and Turku University Hospitals (grant X51001); Juho Vainio Foundation; Paavo Nurmi Foundation; Finnish Foundation for Cardiovascular Research; Finnish Cultural Foundation; The Sigrid Jusélius Foundation; Tampere Tuberculosis Foundation; Emil Aaltonen Foundation; Yrjö Jahnsson Foundation; Signe and Ane Gyllenberg Foundation; Diabetes Research Foundation of Finnish Diabetes Association; EU Horizon 2020 (grant 755320 for TAXINOMISIS and grant 848146 for To Aition); European Research Council (grant 742927 for MULTIEPIGEN project); Tampere University Hospital Supporting Foundation; Finnish Society of Clinical Chemistry; and the Cancer Foundation Finland. The KORA study was initiated and financed by the Helmholtz Zentrum München—German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education and Research (BMBF) and by the State of Bavaria. KORA research was also supported within the Munich Center of Health Sciences, Ludwig-Maximilian University, as part of LMUinnovativ. The KORA-MRI sub-study received funding from the German Research Foundation (DFG, Deutsche Forschungsgemeinschaft). The KORA-MRI sub-study was supported by an unrestricted grant from Siemens Healthcare. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr. Danielsson was supported by grants from the Helsinki University Hospital Research Fund and by grants from the Sigrid Jusélius Foundation and Mary and Georg Ehrnrooth Foundation. Dr. Nano: no personal grants to declare. Dr. Pahkala: was supported by Academy of Finland research fellowship (no. 322112). Dr. Rospleszcz: no personal grants to declare. Dr. Lehtimäki: no personal grants to declare. Dr. Schlett was supported by the German Research Foundation (DFG, Bonn, Germany; Project ID 245222810). Dr. Kähönen: no personal grants to declare. Dr. Bamberg: no personal grants to declare. Dr. Raitakari: no personal grants to declare. Dr. Peters: no personal grants to declare. Dr. Nissinen was supported by grants from the Helsinki University Hospital Research Fund. Dr. Åberg was supported by the Academy of Finland (grant #338544), Sigrid Jusélius Foundation, Mary and Georg Ehrnrooth Foundation, Medicinska Understödsföreningen Liv och Hälsa, and Finska Läkaresällskapet.