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Fatty Liver Index – What is the FLI?

The Fatty Liver Index (FLI) is a calculated score used to estimate the risk of hepatic steatosis. It is derived from routine blood and body measurements.

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Things worth knowing about "Fatty Liver Index"

The Fatty Liver Index (FLI) is a calculated score used to estimate the risk of hepatic steatosis. It is derived from routine blood and body measurements.

What is the Fatty Liver Index?

The Fatty Liver Index (FLI) is a mathematically calculated score designed to estimate the presence of hepatic steatosis (fatty liver) without the need for liver biopsy or imaging. It was developed in 2006 by Bedogni and colleagues and has since become a widely used non-invasive screening tool in clinical practice.

A high FLI value indicates an increased likelihood of fatty liver disease and helps clinicians identify at-risk patients at an early stage.

How is the Fatty Liver Index Calculated?

The FLI is derived from four measurements:

Triglycerides (blood lipid levels)
Body Mass Index (BMI)
Gamma-Glutamyltransferase (GGT) (a liver enzyme measured in the blood)
Waist circumference

These values are entered into a logistic regression formula that produces a score between 0 and 100. The interpretation is as follows:

FLI < 30: Fatty liver unlikely
FLI 30–59: Indeterminate range
FLI ≥ 60: Fatty liver likely

Clinical Relevance

The FLI is a recognized tool for the early detection of non-alcoholic fatty liver disease (NAFLD) as well as alcoholic fatty liver. Since both conditions are often asymptomatic for many years, a reliable and non-invasive screening test is of great clinical value.

An elevated FLI is also associated with an increased risk of type 2 diabetes, cardiovascular disease, and metabolic syndrome. Research indicates that the FLI can serve as an independent predictor of these conditions.

Advantages and Limitations of the FLI

Advantages

Can be calculated from routine laboratory and anthropometric data
No invasive procedures or expensive imaging required
Well validated across diverse population groups
Suitable for large-scale epidemiological studies and everyday clinical use

Limitations

The FLI cannot definitively diagnose or rule out fatty liver disease
It does not replace ultrasound or liver biopsy in cases of suspected advanced liver disease
Accuracy may vary across certain demographic or ethnic groups

What to Do with an Elevated FLI?

If the FLI is 60 or above, further medical evaluation is recommended. This typically includes:

Liver ultrasound
Comprehensive blood tests (liver enzymes, blood glucose, lipid panel)
Assessment of lifestyle factors (diet, alcohol consumption, physical activity)

The primary treatment strategies for fatty liver disease include weight loss, dietary changes, and regular physical activity. In many cases, these measures can significantly improve or even fully reverse hepatic steatosis.

References

Bedogni G, Bellentani S, Miglioli L, et al. - The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterology, 2006;6:33.
European Association for the Study of the Liver (EASL) - EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis. Journal of Hepatology, 2021;75(3):659–689.
Stefan N, Kantartzis K, Häring HU - Causes and metabolic consequences of Fatty Liver. Endocrine Reviews, 2008;29(7):939–960.

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