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: 
 Elisabetta E Bugianesi Reviewer: 
Reviewer's report: 
General 
The manuscript by Bedogni et al is aimed at developing an algorithm to predict liver steatosis in the general 
population. 216 subjects with non-viral suspected liver disease (SLD) were selected from the data base of 
the Dionysos study and matched with 280 subjects without SLD. 
All participants had been evaluated for liver steatosis on ultrasound and for several anthropometric, clinical 
and biochemical parameters. A composite “fatty liver index” (FLI) derived from BMI, waist circumference, 
triglycerides and GGT is obtained, to predict the presence (SP=86%) or the absence (SN=97%) of liver steatosis. 
The study is conducted on a large sample of subjects from the general population, extensively investigated. 
All the parameters are carefully analysed by appropriate statistic methods, the results are clear and 
conclusions supported by the data 
The main strength of this study is that the FLI is derived on sound data from a large sample size of the general population and is based on parameters easily available in clinical practice. 
Limitations include the lack of a validation group and of a cost effectiveness analysis versus US screening. 
Nevertheless, FLI may represent a valid tool in decision making during the screening of NAFLD. 
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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) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after discretionary revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No 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: 
 Elisabetta E Bugianesi Reviewer: 
Reviewer's report: 
General 
The manuscript by Bedogni et al is aimed at developing an algorithm to predict liver steatosis in the general 
population. 216 subjects with non-viral suspected liver disease (SLD) were selected from the data base of 
the Dionysos study and matched with 280 subjects without SLD. 
All participants had been evaluated for liver steatosis on ultrasound and for several anthropometric, clinical 
and biochemical parameters. A composite “fatty liver index” (FLI) derived from BMI, waist circumference, 
triglycerides and GGT is obtained, to predict the presence (SP=86%) or the absence (SN=97%) of liver steatosis. 
The study is conducted on a large sample of subjects from the general population, extensively investigated. 
All the parameters are carefully analysed by appropriate statistic methods, the results are clear and 
conclusions supported by the data 
The main strength of this study is that the FLI is derived on sound data from a large sample size of the general population and is based on parameters easily available in clinical practice. 
Limitations include the lack of a validation group and of a cost effectiveness analysis versus US screening. 
Nevertheless, FLI may represent a valid tool in decision making during the screening of NAFLD. 
------------------------------------------------------------------------------- 
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) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after discretionary revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No 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: 
 Elisabetta E Bugianesi Reviewer: 
Reviewer's report: 
General 
The manuscript by Bedogni et al is aimed at developing an algorithm to predict liver steatosis in the general 
population. 216 subjects with non-viral suspected liver disease (SLD) were selected from the data base of 
the Dionysos study and matched with 280 subjects without SLD. 
All participants had been evaluated for liver steatosis on ultrasound and for several anthropometric, clinical 
and biochemical parameters. A composite “fatty liver index” (FLI) derived from BMI, waist circumference, 
triglycerides and GGT is obtained, to predict the presence (SP=86%) or the absence (SN=97%) of liver steatosis. 
The study is conducted on a large sample of subjects from the general population, extensively investigated. 
All the parameters are carefully analysed by appropriate statistic methods, the results are clear and 
conclusions supported by the data 
The main strength of this study is that the FLI is derived on sound data from a large sample size of the general population and is based on parameters easily available in clinical practice. 
Limitations include the lack of a validation group and of a cost effectiveness analysis versus US screening. 
Nevertheless, FLI may represent a valid tool in decision making during the screening of NAFLD. 
------------------------------------------------------------------------------- 
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) 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
 Accept after discretionary revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests 
assistant