Fatty Liver Index as a Predictor of Metabolic Syndrome in Adult Females in India

Background : Metabolic associated fatty liver disease (MAFLD) is considered the hepatic manifestation of metabolic syndrome (MetS). Fatty liver index (FLI) is a validated model to detect MAFLD. This study aimed to evaluate the accuracy of FLI in predicting MetS in adult females in India. Methods : This cross-sectional study included 450 adult females attending a tertiary care hospital in India. Clinical examination, anthropometric measurements, and biochemical tests were conducted. FLI was calculated using the standard formula. Mets were diagnosed using harmonized criteria. Logistic regression analysis was performed to determine predictors. Results : The mean age was 44.2±7.8 years and the prevalence of MetS was 61%. Increasing the FLI category was significantly associated with a worsening metabolic profile. The odds of hypertension, diabetes, MetS, and cardiovascular disease progressively increased with higher FLI levels (p<0.001), denoting a dose-response relationship. FLI demonstrated good diagnostic accuracy for MetS with AUC 0.86 (95% CI 0.81–0.89). It showed significantly higher predictive ability compared to individual components like waist circumference and lipids. A FLI cutoff ≥30 provided an optimal balance of sensitivity (71%) and specificity (59%) for predicting MetS. Conclusion : FLI demonstrates a strong association with MetS and related comorbidities in a dose-dependent manner. It shows good diagnostic accuracy for predicting MetS, better than individual criteria. FLI can be a simple, low-cost screening tool to identify high metabolic risk individuals in resource-limited settings.