Fatty Liver Index Dynamics as a Predictor of Hepatocellular Carcinoma in Patients with Type 2 Diabetes Mellitus and Non-Cirrhotic Livers

Q: What was the study’s goal regarding fatty liver index (FLI)?

To determine whether baseline FLI and dynamic changes in FLI can identify patients with type 2 diabetes mellitus who have a higher risk of hepatocellular carcinoma despite having non-cirrhotic livers.

Q: How was HCC detected in this study?

HCC cases were identified using International Classification of Diseases codes and reimbursement records covering 2016 to 2020.

Q: What did the study find about baseline and increasing FLI?

Participants with baseline FLI 30 to 59.9 and those with FLI ≥60 had higher HCC risk than those with FLI <30. An increase from <30 to ≥30 further increased HCC risk.

Sep 29, 2026

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Baseline and longitudinal assessment of fatty liver index (FLI) was evaluated as a practical surveillance tool for hepatocellular carcinoma (HCC) risk in people with type 2 diabetes mellitus and non-cirrhotic livers. Using two health screenings (2012–2015), 92,761 participants were stratified by baseline FLI and FLI change over time; HCC outcomes were identified from disease coding and reimbursement records (2016–2020). Higher baseline FLI and rising FLI conferred increased HCC risk, while FLI reduction was associated with delayed protective effects and lower incidence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

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Background

Methods

Results

Conclusion

Introduction

Original Article Endocrinol Metab 2025;40:883-892 [https://doi.org/10.3803/EnM.2024.2286](https://doi.org/10.3803/EnM.2024.2286)[ ](https://doi.org/10.3803/EnM.2024.2286)[pISSN 2093-596X](pISSN 2093-596X) · eISSN 2093-5978 Fatty Liver Index Dynamics as a Predictor of Hepatocellular Carcinoma in Patients with Type 2 Diabetes Mellitus and Non-Cirrhotic Livers Eun-Hee Cho1, *, Min Gu Kang2, *, Chang Hun Lee3,4, *, Shinyoung Oh5,6, Chen Shen4,6, Ha Ram Oh4,6, Young Ran Park4,6, Hyun Lee7, Jong Seung Kim2,4,8, Ji Hyun Park4,6 1Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon; 2Department of Medical Informatics, 3Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jeonbuk National University Medical School; 4Research Institute of Clinical Medicine, Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital; 5Department of Medicine, Jeonbuk National University Graduate School; 6Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju; 7Department of Internal Medicine, Hanyang University College of Medicine, Seoul; 8Department of Otorhinolaryngology, Jeonbuk National University Medical School, Jeonju, Korea Background: Type 2 diabetes mellitus (T2DM) is a significant risk factor for hepatocellular carcinoma (HCC) in patients with nonalcoholic fatty liver disease; however, surveillance strategies for patients with T2DM, especially without cirrhosis, are inadequate. This study examined whether the fatty liver index (FLI) and its dynamic changes can effectively identify patients with T2DM at increased risk for HCC. Methods: Data from 92,761 individuals with T2DM aged 40 to 79 who underwent two health screenings (2012 to 2015) were analyzed. The FLI, calculated using waist circumference, body mass index, triglycerides, and gamma-glutamyl transferase, was used tostratify patients by baseline FLI and FLI changes between screenings. HCC cases were identified via International Classification of Diseases codes and reimbursement records (2016 to 2020) . Results: Patients with baseline FLI of 30 to 59.9 had a 1.90-fold higher risk (P<0.01) and those with FLI ≥60 had a 2.94-fold higher risk (P<0.01) of developing HCC compared to those with FLI <30. An increase in FLI from <30 to ≥30 resulted in a 2.10-fold higher risk of HCC (P<0.01), while a reduction in FLI from ≥30 to <30 led to a 0.64-fold lower risk (P = 0.03) . Protective benefits ofFLI reduction took approximately 3 years to manifest. Conclusion: Baseline and dynamic monitoring of FLI effectively identified HCC risk in T2DM patients with non-cirrhotic livers, supporting early detection and intervention. | Keywords: Diabetes mellitus, type 2; Carcinoma, hepatocellular; Risk; Non-alcoholic fatty liver disease | | | --- | --- | | Received: 15 December 2024, Revised: 26 February 2025, Accepted: 13 March 2025
Corresponding author: Ji Hyun Park
Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea
Tel: +82-63-250-1780, Fax: +82-63-254-1609, [E-mail:](E-mail: parkjh@jbnu.ac.kr)[ parkjh@jbnu.ac.kr](E-mail: parkjh@jbnu.ac.kr)[ ](E-mail: parkjh@jbnu.ac.kr)*These authors contributed equally to this work. | Copyright © 2025 Korean Endocrine Society
This is an Open Access article distributed under the terms of
the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
| [www.e-enm.org](www.e-enm.org) 883 Cho EH, et al. INTRODUCTION Hepatocellular carcinoma (HCC) is a serious complication of non-alcoholic fatty liver disease (NAFLD), currently

FAQs

What was the study’s goal regarding fatty liver index (FLI)?

To determine whether baseline FLI and dynamic changes in FLI can identify patients with type 2 diabetes mellitus who have a higher risk of hepatocellular carcinoma despite having non-cirrhotic livers.

How was HCC detected in this study?

HCC cases were identified using International Classification of Diseases codes and reimbursement records covering 2016 to 2020.

What did the study find about baseline and increasing FLI?

Participants with baseline FLI 30 to 59.9 and those with FLI ≥60 had higher HCC risk than those with FLI <30. An increase from <30 to ≥30 further increased HCC risk.

Sep 29, 2026

Uploaded by Rowan