An abattoir-based cohort study using liver and serum specimens from Holstein dairy cows (452 healthy and 54 fatty liver cases) was conducted. Serum fructosamine and other biochemical parameters and fat content of liver specimens were measured. There were significant negative correlations of fructosamine with hepatic lipid content (P = 0.001), and serum total bilirubin (P = 003) and significant positive correlation with glucose (P < 0.02), albumin (P < 0.0001) and cholesterol (P < 0.0001) within normal cows. In fatty liver-affected cows significant positive correlations were seen between fructosamine and cholesterol (P < 0.0001) and albumin (P < 0.0001). In addition fructosamine had a significant negative correlation with the ratio of non-esterified fatty acids to cholesterol in both normal (P < 0.0001) and fatty liver-affected cows (P = 0.006). We found that serum fructosamine concentration was lower (P < 0.001) in cows suffering from fatty liver. The area under the receiver operating characteristic curve of fructosamine for diagnosis of fatty liver was 67.6. Optimum fructosamine cut-point based on the maximum total of sensitivity (SE) and specificity (SP) was <213 mmol/L (SE = 71%; SP = 65). Cows with serum fructosamine concentrations below 213 mmol/L were 4.5 times more likely to have hepatic lipidosis (odds ratio = 4.5; 95% CI = 2.4–8.6; P < 0.0001). We found that fructosamine showed a combination of high SE, SP, which was greater than aspartate aminotransferase, non-esterified fatty acids, b-hydroxybutyrate, total cholesterol, bile acids and bilirubin. In addition, fructosamine showed a positive likelihood ratio of 2.0, and negative likelihood ratio of 0.45. In conclusion, the present results indicate that fructosamine measurement could improve the diagnosis of fatty liver in dairy cows.

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