In this study, researchers from Richmond, Virginia, characterized the clinical and histologic features of those with nonalcoholic fatty liver disease (NAFLD) and normal alanine aminotransferase (ALT) values.
They also compared the spectrum of NAFLD associated with normal versus elevated ALT levels.
|80% of patients had at least 1 feature of the metabolic syndrome.|
The team determined whether there were differences in the clinical or histologic spectrum of NAFLD between those with a low normal versus high normal ALT value.
The research team identified 51 subjects with NAFLD and normal ALT. They compared these patients with 50 consecutive subjects with NAFLD and elevated ALT.
The 2 groups were comparable with respect to age, gender distribution, and ethnicity. They were also comparable with respect to the grade of the individual histologic parameters of NAFLD.
The team determined that indications for liver biopsy in the normal ALT group were unexplained hepatomegaly (n = 21) or evaluation as a potential donor for living donor liver transplantation (n = 16).
The researchers found that about 80% of patients had at least 1 feature of the metabolic syndrome, the major risk factor for NAFLD.
They identified 12 subjects with normal ALT levels and bridging fibrosis. In addition, 6 had cirrhosis.
Diabetes was the only factor independently associated with an increased risk of advanced fibrosis (relative risk, 2.3).
The team also found that mean steatosis and perisinusoidal fibrosis scores were lower in those with low normal ALT, compared with those with high normal ALT.
However, the prevalence of advanced fibrosis was similar.
Dr Pouneh Mofrad’s team concluded, “The entire histologic spectrum of NAFLD can be seen in individuals with normal ALT values”.
And, “The histologic spectrum in these individuals is not significantly different from those with elevated ALT levels”
In addition, “A low normal ALT value does not guarantee freedom from underlying steatohepatitis with advanced fibrosis”.