University of Oulu

Nivukoski, U., Niemelä, M., Bloigu, A. et al. Combined effects of lifestyle risk factors on fatty liver index. BMC Gastroenterol 20, 109 (2020).

Combined effects of lifestyle risk factors on fatty liver index

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Author: Nivukoski, Ulla1; Niemelä, Markus1,2; Bloigu, Aini3;
Organizations: 1Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Hanneksenrinne 7, 60220, Seinäjoki, Finland
2Faculty of Medicine, University of Oulu, 90014, Oulu, Finland
3Center for Life Course Health Research, University of Oulu, 90014, Oulu, Finland
4Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland
5Department of Psychiatry, Seinäjoki Central Hospital and Tampere University, 33014, Tampere, Finland
6National Institute for Health and Welfare (THL), 00271, Helsinki, Finland
7The Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210, Kuopio, Finland
8Joint Municipal Authority for North Karelia Social and Health Services, 80100, Joensuu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Springer Nature, 2020
Publish Date: 2020-06-23


Background: Factors of lifestyle may have a major impact on liver-related morbidity and mortality. We examined independent and joint effects of lifestyle risk factors on fatty liver index (FLI), a biomarker of hepatic steatosis, in a population-based cross-sectional national health survey.

Methods: The study included 12,368 participants (5784 men, 6584 women) aged 25–74 years. Quantitative estimates of alcohol use, smoking, adiposity and physical activity were used to establish a total score of risk factors, with higher scores indicating an unhealthier lifestyle. FLI was calculated based on an algorithm including body mass index, waist circumference, serum gamma-glutamyltransferase and triglycerides.

Results: The occurrence of FLI ≥ 60% indicating fatty liver increased from 2.4% in men with zero risk factors to 81.9% in those with a total risk score of 7–8 (p <  0.0005 for linear trend) and in women from 0 to 73.5% (p <  0.0005). The most striking individual impacts on the likelihood for FLI above 60% were observed for physical inactivity (p <  0.0005 for both genders) and alcohol consumption (p <  0.0005 for men). Interestingly, coffee consumption was also found to increase with increasing risk factor scores (p <  0.0005 for linear trend in both genders).

Conclusions: The data indicates that unfavorable combinations of lifestyle risk factors lead to a high likelihood of hepatic steatosis. Use of FLI as a diagnostic tool may benefit the assessment of interventions aimed at maintaining a healthy lifestyle and prevention of liver-related morbidity.

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Series: BMC gastroenterology
ISSN: 1471-230X
ISSN-E: 1471-230X
ISSN-L: 1471-230X
Volume: 20
Article number: 109
DOI: 10.1186/s12876-020-01270-7
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported in part by Competitive State Research Financing of the Expert Responsibility area of Seinäjoki Central Hospital and University of Tampere, VTR 5300/3116 and by the Finnish Foundation for the Promotion of Laboratory Medicine.
Copyright information: © The Author(s). 2020. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.