Open Access Research article

A simple index of lipid overaccumulation is a good marker of liver steatosis

Giorgio Bedogni12*, Henry S Kahn3, Stefano Bellentani4 and Claudio Tiribelli1

Author Affiliations

1 University of Trieste and Liver Research Center, Building Q, AREA Science Park, Strada Statale 14/km 163.5, 34012 Basovizza, Trieste, Italy

2 Department of Maternal and Pediatric Sciences, University of Milan, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milano, Italy

3 National Center for Chronic Disease Prevention and Health Promotion, Atlanta, USA

4 Liver Center, Azienda USL Modena, "Ramazzini" Hospital, Carpi, Modena, Italy

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BMC Gastroenterology 2010, 10:98  doi:10.1186/1471-230X-10-98

Published: 25 August 2010



Liver steatosis is often found in association with common cardiometabolic disorders, conditions that may all occur in a shared context of abdominal obesity and dyslipidemia. An algorithm for identifying liver steatosis is the fatty liver index (FLI). The lipid accumulation product (LAP) is an index formulated in a representative sample of the US population to identify cardiometabolic disorders. Because FLI and LAP share two components, namely waist circumference and fasting triglycerides, we evaluated the ability of LAP to identify liver steatosis in the same study population from the Northern Italian town where FLI was initially developed.


We studied 588 individuals (59% males) aged 21 to 79 years. Liver steatosis was detected by ultrasonography and coded ordinally as none, intermediate and severe. 44% of the individuals had liver steatosis. Using proportional-odds ordinal logistic regression, we evaluated the ability of log-transformed LAP (lnLAP) to identify liver steatosis. We considered the benefits to our model of including terms for sex, age, suspected liver disease and ethanol intake. We calculated the 3-level probability of liver steatosis according to lnLAP and sex, providing tables and nomograms for risk assessment.


An ordinal proportional-odds model consisting of lnLAP and sex offered a reasonably accurate identification of liver steatosis. The odds of more severe vs. less severe steatosis increased for increasing values of lnLAP (odds ratio [OR] = 4.28, 95%CI 3.28 to 5.58 for each log-unit increment) and was more likely among males (OR = 1.88, 95%CI 1.31 to 2.69).


In a study sample of adults from Northern Italy, the simple calculation of LAP was a reasonably accurate approach to recognizing individuals with ultrasonographic liver steatosis. LAP may help primary care physicians to select subjects for liver ultrasonography and intensified lifestyle counseling, and researchers to select patients for epidemiologic studies. A more thorough assessment of LAP's potential for identifying liver steatosis will require its cross-evaluation in external populations.