Abstract:
Background: 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 meas-
ure 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.
Methods: 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.
Results: 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%).
Conclusion: FLI could accurately be used in resource limited community settings and in epidemiological studies to
screen overweight and obese children for NAFLD.
