Non-alcoholic Fatty Liver, Risk Factors and Diagnostic Challenges in the Georgian Population
DOI:
https://doi.org/10.52340/GBMN.2025.01.01.117Keywords:
Fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation product (LAP), non-alcoholic fatty liver disease (NAFLD), ultrasoundAbstract
Background: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease in human history, characterized by the excessive accumulation of lipid granules in liver hepatocytes (steatosis) in the absence of other etiologies, such as excessive alcohol intake or the use of hepatotoxic drugs. Multiple risk factors predispose to the development and progression of NAFLD. Developing reliable and practical tools for diagnosing NAFLD during disease screening is crucial for the early detection and effective treatment of NAFLD. Early diagnosis may help apply appropriate preventive measures to prevent the progression of advanced liver diseases. Several clinical indices have been evaluated for the diagnosis of NAFLD, including the Fatty Liver Index (FLI), the Hepatic Steatosis Index (HSI), and the Lipid Accumulation Product (LAP). This non-invasive testing, combined with ultrasound, can be used as a powerful method for diagnosing NAFLD. Objectives: This study aimed to identify the primary risk factors of NAFLD in an adult population in Georgia and compare clinical indices with hepatic ultrasound data for the diagnosis of NAFLD. Methods: A total of 360 subjects were included in the study. We evaluated for BMI, waist circumference, presence of hypertension, diabetes, metabolic syndrome, ALT, AST, GGT, serum lipids, albumin, and CBC. Results: There was no significant difference in age between the groups. There was also no statistically significant difference between the groups in terms of physical activity and the incidence of chronic kidney disease. In patients with NAFLD, the incidence of diabetes, dyslipidemia, metabolic syndrome, and hypertension was significantly higher compared to the control group. As laboratory studies have shown, NADL patients exhibited significantly higher levels of transaminases, triglycerides, glucose, and platelets, as well as significantly lower levels of albumin. In 250 patients with NAFLD, we studied clinical indices and ultrasound grading of this disease. Grade 1 had 88(35.2%) patients; grade 2 – 104(41.6%) and grade 3 – 58(23.2%) patients. FLI incidence in patients with NAFLD with a cat-off value of score >30 and <60 was 222 (88.8%). HSI incidence in patients with NAFLD with a cat-off value of score >36 was 203 (81.2%), and LAP incidence in patients with NAFLD with a cat-off value of score >30 was 188 (75.2%). The sensitivity and specificity of FLI for diagnosing NAFLD were 95.7% and 73.6%, respectively. For HSI, they were 91% and 70%, respectively, and for LAP, they were 93.5% and 86%. The study of clinical indices and comparison with ultrasound data showed that all clinical indices correlate with the grades of hepatic steatosis. Conclusions: In conclusion, we analyzed the medical examination information of the Georgian population, and the results showed that the occurrence of NAFLD is closely related to METs. Individuals should manage their BMI, blood glucose levels, hypertension, blood lipids, and liver function tests to prevent the development of NAFLD. Our study verifies the accuracy of clinical indices, including FLI, HIS, and LAP, for diagnosing NAFLD as assessed using ultrasound examination. Therefore, clinical indices, combined with ultrasound, are a powerful and valuable diagnostic tool for detecting NAFLD, potentially reducing the need for MRI and liver biopsy.References
The Fatty Liver Index (FLI) represents a non-invasive and well-predictive algorithm for estimating hepatic steatosis. The established method relies on BMI, waist circumference, serum TG, and gamma-glutamyl transferase (GGT) measurements;17
The hepatic steatosis index (HSI) is a screening tool designed to optimize NAFLD and NASH management, helping physicians identify candidates for liver ultrasound and those who require lifestyle modification;18,19
The Lipid Accumulation Product (LAP) is a straightforward algorithm that considers gender, waist circumference, and fasting triglyceride levels.20,21
FLI was calculated based on the following formula: ey/(1 + ey) × 100, where: y = 0.953 ×triglycerides (TGs) (mg/dL) + 0.139 × BMI (kg/m2) + 0.718 × GGT(U/L) + 0.053 ×WC (cm) − 15,745. Values of FLI ranged from 0 to 100 and were classified into three categories: <30 – no steatosis; 30-59 -intermediate state, and ≥60 – hepatic steatosis;
HSI = 8 × (ALT / AST ratio) + BMI +2, if female; +2, if diabetes mellitus. HSI values below 30 indicate that NAFLD can be ruled out (with a negative likelihood ratio of up to 0.186). HSI values of 36 and above indicate that a NAFLD-positive diagnosis is highly likely (with a positive likelihood ratio starting at 6.069);
LAP for men = (Waist circumference(cm)-65) x triglycerides (mmol/l);
LAP for women = (Waist circumference(cm)-58) x triglycerides (mmol/l); There are no universally defined normal values for LAP, but studies suggest that in healthy individuals, LAP values tend to be below 30 cm×mmol/l.
Grade 1: Increased liver echogenicity without fading around the portal vein and diaphragm;
Grade 2: Increased liver echogenicity with fading of the portal vein but without fading of the diaphragm;
Grade 3: Increased echogenicity of the liver with the disappearance of the portal vein and diaphragm.
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