Liver-Related Outcomes in Patients with Nonalcoholic Fatty Liver Disease and Normal Transaminases

Although there is strong evidence that patients with nonalcoholic fatty liver disease (NAFLD) and elevated liver enzymes are at increased risk for liver-related morbidity and mortality, it is unclear if patients with normal liver enzymes are also at increased risk.

In a retrospective cohort study in Veterans Health Administration patients (~90% men), researchers compared incidence of cirrhosis and hepatocellular carcinoma (HCC) between approximately 3500 patients with steatosis and normal alanine aminotransferase (ALT), 15,400 patients with steatosis and elevated ALT, and 9300 with no steatosis and normal ALT. Mean follow-up was 8.4 years.

Compared with patients with steatosis and elevated ALT, those with steatosis and normal ALT had lower an…