Background and Aims: The fatty liver index (FLI) is a simple and non-invasive method for the diagnosis of fatty liver disease with an increased risk of cardiovascular disease (CVD) as well as liver-related mortality. We examined the association between FLI and 10-year CVD risk as determined by the Framingham risk score.

Methods: This cross-sectional study included 7,240 individuals aged 30 to 69 years who underwent a health examination between 2015 and 2017. The FLI was calculated using an algorithm based on triglyceride, γ-glutamyltransferase, body mass index (BMI), and waist circumference. Multiple linear and logistic regression analyses were performed to assess independent relationships between the FLI and Framingham risk score after adjusting for confounding variables.

Results: The overall prevalence of fatty liver disease among study participants as assessed by an FLI ≥ 60 was 19.7%. Compared with non-hepatic steatosis (FLI < 30), the odds ratio (95% confidence interval) for a high Framingham 10-year CVD risk ≥ 10% in individuals with hepatic steatosis (FLI ≥ 60) was 2.56 (1.97–3.33) after adjusting for age, gender, fasting plasma glucose, high-density and low-density lipoprotein cholesterol, blood pressure, C-reactive protein, regular exercise, alcohol-drinking, and current smoking.

Conclusions: The FLI was positively and independently associated with a Framingham 10-year CVD risk in the general Korean population. Our findings suggest that the FLI, a simple, useful, and economical index, may be an indicator of CVD events.


fatty liver index, insulin resistance, cardiovascular disease, Framingham risk score