ANI

 Q: How alcoholic liver disease can be distinguished from nonalcoholic fatty liver disease (NAFLD)? 

 Answer: The ideal way to differentiate alcoholic liver disease from NAFLD is to determine ANI which is alcoholic liver disease to NAFLD index. The formula is 

ANI = -58.5 + 0.637 (MCV) + 3.91 (AST/ALT) – 0.406 (BMI) + 6.35 for men 

Where 

• MCV = mean corpuscular volume 
• AST/ALT = aminotransferase levels 
• BMI = body mass index (BMI) 

ANI greater than zero is probably due to alcoholic liver disease and an ANI less than zero favors NAFLD. 

In the second step, the probability of alcoholic liver disease is then calculated using the value of ANI.

 Probability = eANI/(1+eANI)

The old rule of AST to ALT ratio >2 for alcoholic liver disease still exits true for practical purposes.

#hepatology

References:

Dunn W, Angulo P, Sanderson S, et al. Utility of a new model to diagnose an alcohol basis for steatohepatitis. Gastroenterology 2006; 131:1057.