J Clin Lipidol. 2026 Sep 17:S1933-2874(26)00518-0. doi: 10.1016/j.jacl.2026.09.007. Online ahead of print.
ABSTRACT
BACKGROUND: The fatty liver index (FLI) provides a cost-effective way to screen for metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD is associated with preclinical atherosclerosis, with cardiovascular disease (CVD) mortality being the leading cause of death among MASLD patients.
OBJECTIVE: Lipoprotein particles can provide better CVD risk prediction than traditional lipid measures. Yet, FLI associations with intermediate disease markers remain under-researched. This study addressed this gap by investigating FLI relationships with lipoprotein particle subclass concentrations.
METHODS: This was a cross-sectional study of 1713 middle-aged to older-aged men and women randomly selected from a large primary care center. The FLI was calculated using triglyceride, body mass index, waist circumference, and gamma-glutamyl transferase levels. Lipoprotein particle subclass concentrations and size were determined using nuclear magnetic resonance spectroscopy. Linear regression analyses examined FLI associations with lipoprotein biomarkers.
RESULTS: In fully adjusted models, higher FLI scores were associated with larger very low-density lipoprotein (VLDL) and smaller low-density lipoprotein (LDL) and high-density lipoprotein (HDL) particle size, more large and medium VLDL, small LDL, and less large HDL particle concentrations, and greater lipoprotein-related insulin resistance (all P <.001). In models that examined these variable associations across FLI quintiles, significant dose-response relationships were observed (P trend <.001 for all).
CONCLUSION: These findings support the clinical utility of the FLI as a marker of atherogenic risk and as a tool for identifying at-risk individuals. Incorporating the FLI into CVD risk assessment may help improve risk prediction in individuals with liver disease and guide targeted interventions.
PMID:42850111 | DOI:10.1016/j.jacl.2026.09.007