Fatty liver index and mortality: the Cremona study in the 15th year of follow-up

Hepatology. 2011 Jul;54(1):145-52. doi: 10.1002/hep.24356.


A fatty liver, which is a common feature in insulin-resistant states, can lead to chronic liver disease. It has been hypothesized that a fatty liver can also increase the rates of non-hepatic-related morbidity and mortality. Therefore, we wanted to determine whether the fatty liver index (FLI), a surrogate marker and a validated algorithm derived from the serum triglyceride level, body mass index, waist circumference, and γ-glutamyltransferase level, was associated with the prognosis in a population study. The 15-year all-cause, hepatic-related, cardiovascular disease (CVD), and cancer mortality rates were obtained through the Regional Health Registry in 2011 for 2074 Caucasian middle-aged individuals in the Cremona study, a population study examining the prevalence of diabetes mellitus in Italy. During the 15-year observation period, 495 deaths were registered: 34 were hepatic-related, 221 were CVD-related, 180 were cancer-related, and 60 were attributed to other causes. FLI was independently associated with the hepatic-related deaths (hazard ratio = 1.04, 95% confidence interval = 1.02-1.05, P < 0.0001). Age, sex, FLI, cigarette smoking, and diabetes were independently associated with all-cause mortality. Age, sex, FLI, systolic blood pressure, and fibrinogen were independently associated with CVD mortality; meanwhile, age, sex, FLI, and smoking were independently associated with cancer mortality. FLI correlated with the homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance (Spearman's ρ = 0.57, P < 0.0001), and when HOMA-IR was included in the multivariate analyses, FLI retained its association with hepatic-related mortality but not with all-cause, CVD, and cancer-related mortality.

Conclusion: FLI is independently associated with hepatic-related mortality. It is also associated with all-cause, CVD, and cancer mortality rates, but these associations appear to be tightly interconnected with the risk conferred by the correlated insulin-resistant state.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Algorithms*
  • Body Mass Index*
  • Cardiovascular Diseases / mortality
  • Cohort Studies
  • Fatty Liver / diagnosis*
  • Fatty Liver / mortality*
  • Fatty Liver / physiopathology
  • Female
  • Follow-Up Studies
  • Humans
  • Insulin Resistance
  • Italy
  • Liver Diseases / mortality
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms / mortality
  • Prognosis
  • Proportional Hazards Models
  • Registries
  • Risk Factors
  • Survival Rate
  • Triglycerides / blood*
  • Waist Circumference*
  • gamma-Glutamyltransferase / blood*


  • Triglycerides
  • gamma-Glutamyltransferase