Nonalcoholic Steatohepatitis and Fibrosis in Patients with “Normal” ALT Levels

Recent data suggest that nonalcoholic fatty liver disease (NAFLD) is underdiagnosed when thresholds of ≈40 IU/L for serum alanine or aspartate aminotransferase (ALT or AST) are used to trigger evaluation. In this study, French researchers performed liver biopsies in 330 patients with type 2 diabetes who had suspected NAFLD based on either elevated transaminases or steatosis on ultrasound. One third of patients had ALT levels lower than 40 IU/L (but ≥20 IU/L for women and ≥30 IU/L for men). Patients who drank alcohol excessively and patients with other hepatic diagnoses were excluded.

Median age was 59, and median body-mass index was 32 kg/m². Liver biopsy revealed nonalcoholic steatohepatitis (NASH) in 58% of patients and advanced fibrosis i…