The Value Of Fatty Liver Index In The Diagnosis Of Type 2 Diabetes Mellitus With Non-alcoholic Fatty Liver Disease

Objective: We aimed to compare the coincidence rate of Fatty Liver Index(FLI)and ultrasonography in the diagnosis of non alcoholic fatty liver disease(NAFLD)in patients with Type 2 diabetes Mellitus(T2DM),and to explore the value of FLI in the diagnosis of NAFLD in patients with T2 DM,so as to find a more safe and convenient method for the screening and diagnosis of T2 DM with NAFLD.Methods:A retrospective review of 271 patients with T2 DM admitted to Hebei Medical University from April 2019 to October 2019.Age,gender,waist circumference(WC),body mass index(BMI),triglyceride(TG),gamma-glutamyl transferase(GTT)and other biochemical parameters were measured and FLI was calculated.Hepatic steatosis was detected by high-resolution ultrasound.Receiver Operating Characteristic(ROC)curve was used to evaluate the predictive value of FLI for NAFLD diagnosed by ultrasound and to compare the coincidence rate between NAFLD defined by FLI and NAFLD diagnosed by high-resolution ultrasound.Results: 1.A total of 271 patients with type 2 diabetes were included in this study,Among them,151 were male,accounting for 55.7%,and 120 were female,accounting for 44.3%;The oldest was 85 years old,and the youngest was 14 years old,with an average age of 55.5(±14.5)years old.The minimum height is 140.0cm and the maximum height is 190.0cm,with an average height of 166.4(±8.8)cm.The lightest weight was 42.3kg,the heaviest 123.3kg,and the average weight was 73.9(±13.3)kg.The minimum BMI was 16.09kg/m~2,the maximum was 41.09kg/m~2,and the average BMI was 26.6(±3.6)kg/m~2.The minimum waist circumference was 60.0cm,the maximum was 116.0cm,and the average waist circumference was 92.0(86.0-99.0)cm.2.163 patients with NAFLD were diagnosed by ultrasonography,including 103 patients with mild,49 patients with moderate and 11 patients with severe hepatic steatosis.3.FLI predicted area under curve of NAFLD for subjects with type 2 diabetes was 0.825,95% confidence interval(CI): 0.700-0.816,and the best cut-off value calculated from Jordan index was 30,when FLI ≥30 was selected as the cut-off point for the screening and diagnosis of NAFLD,the sensitivity and specificity rate were 90.2% and 62.0% respectively,p < 0.001;The detection rate of NAFLD-FLI was 71.2% in patients with type 2 diabetes.4.The agreement between NAFLD defined by FLI and NAFLD diagnosed by ultrasound was as follows: the degree of hepatic steatosis was mild(89.3%),moderate(96.0%)and severe(100%).5.The area under the ROC curve for BMI diagnosis of NAFLD was 0.758,and the 95% confidence interval(CI)was 0.700-0.816.The area under the ROC curve for WC diagnosis of NAFLD was 0.751,and the 95% confidence interval was 0.693-0.810.The area under the ROC curve for GGT diagnosis of NAFLD was 0.706,and the 95% confidence interval was 0.643-0.769.The area under the ROC curve for TG diagnosis of NAFLD was 0.722,and the 95% confidence interval was 0.661-0.783.All P values < 0.001.BMI,WC,GGT and TG are closely related to FLI and can be used as predictors of NAFLD.6.Sex and age: In patients with Type 2 diabetes,the prevalence of NAFLD diagnosed by ultrasound was 66.2% in males and 52.5% in females,P=0.015;the prevalence of NAFLD defined by FLI was 79.5% in males and 60.8% in females,P=0.001,men have higher FLI than women;The average age of all subjects was 55.5(± 14.5)years old;The average age of the patients with NAFLD diagnosed by ultrasound was 53.3 years(±14.7)and that of the undiagnosed patients was 58.7 years(±13.8),p < 0.001.The mean age of patients with NAFLD defined by FLI was 53.6(±14.0)years old,and the mean age of patients without NAFLD was 60.1(±14.9)years old,P=0.001.7.The prevalence of obesity in patients with NAFLD-FLI was 42.7%,while the central obesity rate was 85.3%.Central obesity has a greater impact on NAFLD than normal obesity.Conclusion:1.FLI and ultrasound diagnosis of T2 DM combined with NAFLD have good coincidence rate,especially for moderate and severe hepatic steatosis.2.FLI was higher in Male than female patients with T2 DM and NAFLD.3.Central obesity is associated more closely with T2 DM and NAFLD than general obesity.4.FLI has diagnostic value in patients with T2 DM and NAFLD,especially in medium to serious cases.It is suitable for epidemiological study of large sample and guiding the early screening,intervention and treatment of NAFLD in T2 DM.