Fatty Liver Index (FLI) is the best score to predict MASLD with 50% lower cut-off value in women than in men

• Published in: Biology of sex differences Vol. 15; no. 1; pp. 43 - 13
• Main Authors: Crudele, Lucilla, De Matteis, Carlo, Novielli, Fabio, Di Buduo, Ersilia, Petruzzelli, Stefano, De Giorgi, Alessia, Antonica, Gianfranco, Berardi, Elsa, Moschetta, Antonio
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.05.2024; BioMed Central; BMC
• Subjects: Adipocytes; Adult; Aged; Atherosclerosis; Biomarkers; Biopsy; Blood pressure; Body mass index; Cancer; Cholesterol; Chronic illnesses; Development and progression; Diabetes; Disease prevention; Fatty liver; Fatty Liver - diagnosis; Fatty Liver - diagnostic imaging; Female; Gender difference; Gender differences; Glucose; Gut-liver axis; Humans; Inflammation; Insulin resistance; ISO standards; Lifestyles; Liver; Liver diseases; Liver steatosis; Male; MASLD; Metabolic disorders; Metabolic syndrome; Metabolic Syndrome - diagnosis; Metabolism; Middle Aged; Non-invasive tests; Nutrition research; Patients; Sex Characteristics; Steatosis; Type 2 diabetes; Ultrasonic imaging; Ultrasonography; Ultrasound imaging; Women; Womens health; Taiwan; United States > US; Italy; Non-invasive tests; MASLD; Metabolism; Gender difference; Gut-liver axis; Liver steatosis
• ISSN: 2042-6410; 2042-6410
• DOI: 10.1186/s13293-024-00617-z

Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by the presence of hepatic steatosis, detected on ultrasonography (US) imaging or histology, and at least one of criteria for Metabolic Syndrome diagnosis. Simple non-invasive tests (NITs) have been proposed as an acceptable alternative when US and biopsy are not available or feasible but have not been validated for MASLD. In this observational study, we investigated the reliability of NITs for MASLD detection and whether sex-differences in screening methods should be considered. We included 1069 individuals (48% males and 52% females) who underwent their first clinical examination for Metabolic Syndrome in the period between January 2015 and December 2022. Liver steatosis was detected through US and anthropometric and clinical parameters were recorded. Liver steatosis was detected in 648 patients and MASLD was diagnosed in 630 subjects (355 males; 275 females). Women with MASLD showed better metabolic profile and lower prevalence of Metabolic Syndrome criteria than men. Among NITs, Fatty Liver Index (FLI) showed the best ability for detection of MASLD, with a cut-off value of 44 (AUC = 0.82). When considering the two sexes for MASLD detection via FLI, despite no substantial differences regarding FLI correlations with metabolic biomarkers except for age, women showed marked lower FLI cut-off value (32; AUC = 0.80) than men (60; AUC = 0.80). In this study, we found that FLI is the best non-invasive predictor of both liver steatosis and MASLD. The finding that in women FLI cut-off value for MASLD detection is 50% lower than in men suggests the need of a sex-specific personalized program of screening and prevention of dysmetabolism-related liver diseases, despite outwardly healthy biomarkers profile.