Reviewer's report 
 The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population Title: 
 2  16 September 2006 Version: Date: 
 Helena Cortez-Pinto Reviewer: 
Reviewer's report: 
General 
In the present study, the authors developed an algorithm based on BMI, waist circumference, triglycerides 
and GGT, that was then used to develop a fatty liver index, to detect the presence of fatty liver. The authors 
take advantage of the Dionysos database, to perform the present study, with a very significant number of 
patients. Devising this fatty liver index may be very useful in clinical practise, although it can be argued that 
at the present time, doing ultrasound is almost always included in the investigation of any patient suspected 
of liver disease. However, as mentioned by the authors, it may be useful in a general practise, to select 
patients for doing liver ultrasonography or in research to select patients for epidemiological studies, although it is a formula that can only be used through the use of a palm top or some other computerized 
system, and still has the problem of having a grey area (between 30 and 60) where no conclusions can be 
drawn. 
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Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 1) In what relates to ethanol intake, the fact that the authors used the mean daily ethanol intake, and no correlation was found with the presence of fatty liver is not surprising, since it is the minority who have a 
high alcohol intake that will have fatty liver, so the assertion in the Discussion that “Ethanol intake was not 
associated with FL in any of the models” is not entirely correct. 2) In Table 1, it is not clearly stated what are the numbers in parenthesis; besides although in the legend it is written: “values are medians and interquartile ranges for continuous variables and number of subjects for 
categorical variables”, I do not see any interquartile ranges. The table should be made more clear. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests 
Reviewer's report 
 The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population Title: 
 2  16 September 2006 Version: Date: 
 Helena Cortez-Pinto Reviewer: 
Reviewer's report: 
General 
In the present study, the authors developed an algorithm based on BMI, waist circumference, triglycerides 
and GGT, that was then used to develop a fatty liver index, to detect the presence of fatty liver. The authors 
take advantage of the Dionysos database, to perform the present study, with a very significant number of 
patients. Devising this fatty liver index may be very useful in clinical practise, although it can be argued that 
at the present time, doing ultrasound is almost always included in the investigation of any patient suspected 
of liver disease. However, as mentioned by the authors, it may be useful in a general practise, to select 
patients for doing liver ultrasonography or in research to select patients for epidemiological studies, although it is a formula that can only be used through the use of a palm top or some other computerized 
system, and still has the problem of having a grey area (between 30 and 60) where no conclusions can be 
drawn. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 1) In what relates to ethanol intake, the fact that the authors used the mean daily ethanol intake, and no correlation was found with the presence of fatty liver is not surprising, since it is the minority who have a 
high alcohol intake that will have fatty liver, so the assertion in the Discussion that “Ethanol intake was not 
associated with FL in any of the models” is not entirely correct. 2) In Table 1, it is not clearly stated what are the numbers in parenthesis; besides although in the legend it is written: “values are medians and interquartile ranges for continuous variables and number of subjects for 
categorical variables”, I do not see any interquartile ranges. The table should be made more clear. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests 
Please review this paper.
user
Reviewer's report 
 The fatty liver index: a simple and accurate predictor of hepatic steatosis in the general population Title: 
 2  16 September 2006 Version: Date: 
 Helena Cortez-Pinto Reviewer: 
Reviewer's report: 
General 
In the present study, the authors developed an algorithm based on BMI, waist circumference, triglycerides 
and GGT, that was then used to develop a fatty liver index, to detect the presence of fatty liver. The authors 
take advantage of the Dionysos database, to perform the present study, with a very significant number of 
patients. Devising this fatty liver index may be very useful in clinical practise, although it can be argued that 
at the present time, doing ultrasound is almost always included in the investigation of any patient suspected 
of liver disease. However, as mentioned by the authors, it may be useful in a general practise, to select 
patients for doing liver ultrasonography or in research to select patients for epidemiological studies, although it is a formula that can only be used through the use of a palm top or some other computerized 
system, and still has the problem of having a grey area (between 30 and 60) where no conclusions can be 
drawn. 
------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can be 
reached) 
------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author 
can be trusted to correct) 1) In what relates to ethanol intake, the fact that the authors used the mean daily ethanol intake, and no correlation was found with the presence of fatty liver is not surprising, since it is the minority who have a 
high alcohol intake that will have fatty liver, so the assertion in the Discussion that “Ethanol intake was not 
associated with FL in any of the models” is not entirely correct. 2) In Table 1, it is not clearly stated what are the numbers in parenthesis; besides although in the legend it is written: “values are medians and interquartile ranges for continuous variables and number of subjects for 
categorical variables”, I do not see any interquartile ranges. The table should be made more clear. 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
'I declare that I have no competing interests 
assistant