Department of Paediatrics, University of Ruhuna, Galle, Sri Lanka.
Department of Biochemistry, Faculty of Medicine, University of Ruhuna, Karapitiya, Galle, Sri Lanka.
BMC Pediatr. 2022 Aug 30;22(1):511. doi: 10.1186/s12887-022-03575-w.
Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease among children with a higher prevalence among obese. Fatty liver index (FLI), an algorithm derived to screen NAFLD using the waist circumference, body mass index, triglyceride and gamma glutamyl-transferase concentration was rarely investigated in Asian paediatric population. Since each component is routinely measured in clinical practice, it is feasible to measure FLI even in resource limited settings. Hence, we determined the accuracy of FLI for the screening of NAFLD in obese children in Southern Sri Lanka.
A descriptive cross sectional study was conducted on ninety five children (56 boys) aged 5-15 years with BMI ≥ 85th percentile for age and gender based on CDC 2000 growth charts recruited from the nutrition clinic at the Teaching Hospital, Karapitiya, Sri Lanka. NAFLD was diagnosed by ultrasonography. Factors associated with ultrasonographic fatty liver such as biochemical parameters and fatty liver index in either sex or the whole population were determined by a multivariate analysis. The ability of FLI to screen NAFLD was determined by the analysis of area under the receiver operator characteristic curve (AUROC) and the maximum Youden index analysis.
Overweight and obese children with ultrasonographic fatty liver had a significantly higher FLI than those without fatty liver according to the multivariate analysis performed (Odds ratio 3.524; 95% CI 1.104-11.256, P = 0.033). AUROC of FLI for NAFLD was 0.692 (95% CI; 0.565-0.786) and the optimal cut off value for the screening of NAFLD was 30 (Maximum Youden index 0.2782, Sensitivity, 58.33%; Specificity, 69.49%).
FLI could accurately be used in resource limited community settings and in epidemiological studies to screen overweight and obese children for NAFLD.
非酒精性脂肪性肝病（NAFLD）已成为儿童中最常见的肝病，在肥胖儿童中的发病率更高。脂肪性肝病指数（FLI）是一种通过腰围、体重指数、甘油三酯和γ-谷氨酰转移酶浓度来筛查 NAFLD 的算法，在亚洲儿科人群中很少被研究。由于在临床实践中常规测量每个组成部分，因此即使在资源有限的环境中也可以测量 FLI。因此，我们确定了 FLI 在筛查斯里兰卡南部肥胖儿童 NAFLD 中的准确性。
在斯里兰卡卡拉皮蒂亚教学医院的营养诊所招募了 95 名年龄在 5-15 岁之间、BMI≥年龄和性别为第 85 百分位的儿童（56 名男孩）进行描述性横断面研究。根据美国疾病控制与预防中心 2000 年生长图表，通过超声诊断为非酒精性脂肪性肝病。通过多元分析确定与超声脂肪肝相关的因素，如男女或整个人群的生化参数和脂肪肝指数。通过分析接收者操作特征曲线（AUROC）下的面积和最大 Youden 指数分析来确定 FLI 筛查 NAFLD 的能力。
根据多元分析，超声脂肪肝的超重和肥胖儿童的 FLI 明显高于无脂肪肝的儿童（优势比 3.524；95%可信区间 1.104-11.256，P=0.033）。FLI 对 NAFLD 的 AUROC 为 0.692（95%可信区间为 0.565-0.786），筛查 NAFLD 的最佳截断值为 30（最大 Youden 指数为 0.2782，敏感性为 58.33%，特异性为 69.49%）。
FLI 可在资源有限的社区环境和流行病学研究中准确用于筛查超重和肥胖儿童的 NAFLD。
