University of Oulu

Daniel J. Cuthbertson, Juha Koskinen, Emily Brown, Costan G. Magnussen, Nina Hutri-Kähönen, Matthew Sabin, Päivi Tossavainen, Eero Jokinen, Tomi Laitinen, Jorma Viikari, Olli T. Raitakari & Markus Juonala (2021) Fatty liver index predicts incident risk of prediabetes, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD), Annals of Medicine, 53:1, 1257-1265, DOI: 10.1080/07853890.2021.1956685

Fatty liver index predicts incident risk of prediabetes, type 2 diabetes and non-alcoholic fatty liver disease (NAFLD)

Saved in:
Author: Cuthbertson, Daniel J.1; Koskinen, Juha2,3; Brown, Emily1;
Organizations: 1Metabolism and Nutrition Research Group, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
2Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
3Heart Center, Kotka Central Hospital, Kotka, Finland
4Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
5Department of Pediatrics, Tampere University and Tampere University Hospital, Tampere, Finland
6Murdoch Children’s Research Institute, The Royal Children’s Hospital and University of Melbourne, Melbourne, Australia
7Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
8Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
9Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
10Department of Medicine, University of Turku, Turku, Finland
11Division of Medicine, Turku University Hospital, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
Persistent link:
Language: English
Published: Informa, 2021
Publish Date: 2022-01-18


Aims: To investigate the association between overweight/obesity and fatty liver index (FLI) on the odds of incident prediabetes/type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) in 2020 participants after 10 years follow up.

Methods: At baseline (in 2001) 2020 participants, males and females, aged 24–39 years, were stratified according to body mass index (BMI), normal weight (<25 kg/m²), overweight (≥25–<30 kg/m²), or obese (≥30 kg/m²) and FLI (as high FLI ≥60 or low FLI <60). We examined the incidence of prediabetes/type 2 diabetes and NAFLD (ultrasound assessed) over 10 years to 2011 to determine the relative impact of FLI and BMI.

Results: 514 and 52 individuals developed prediabetes and type 2 diabetes during follow-up. Such individuals were older, with higher BMI, serum glucose, insulin, alanine aminotransferase (ALT) and triglyceride (TG) concentrations than those who did not develop prediabetes or type 2 diabetes (n = 1454). The additional presence of high FLI significantly increased the risk of developing prediabetes and type 2 diabetes above the risk of being overweight/obese. Compared with normal weight, low FLI participants, the odds of prediabetes were ∼2-fold higher and the odds of type 2 diabetes were 9–10-fold higher respectively in the overweight/obese, high FLI group. No difference was observed between normal weight, low FLI and overweight/obese and low FLI groups.

Conclusions: An increased FLI significantly increases the odds of incident prediabetes, type 2 diabetes and NAFLD in individuals with overweight/obese highlighting the contributory role of liver fat accumulation in the pathophysiology of prediabetes/type 2 diabetes.

see all

Series: Annals of medicine
ISSN: 0785-3890
ISSN-E: 1365-2060
ISSN-L: 0785-3890
Volume: 53
Issue: 1
Pages: 1256 - 1264
DOI: 10.1080/07853890.2021.1956685
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The Young Finns Study has been supported by Academy of Finland grants 126925, 121584, 124282, 129378 (Salve), 117797 (Gendi) and 41071 (Skidi); the Social Insurance Institution of Finland; Kuopio, Tampere and Turku University Hospital Medical Funds [grants 9M048 and 9N035]; the Juho Vainio Foundation; the Paavo Nurmi Foundation; the Finnish Foundation for Cardiovascular Research; the Finnish Cultural Foundation; the Tampere Tuberculosis Foundation; and the Emil Aaltonen Foundation. This work was also funded by the National Health and Medical Research Council [grant APP1098369]. C.G.M is supported by a National Heart Foundation of Australia Future Leader Fellowship [100849]. J.K. was supported by Turku University Foundation, Emil Aaltonen Foundation and Urmas Pekkala Foundation.
Copyright information: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.