Normal ALT Levels in NAFLD: Indicative of Milder Liver Damage?

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. NAFLD has two subgroups: simple steatosis, which is considered benign and nonprogressive, and nonalcoholic steatohepatitis (NASH), which can be progressive and lead to cirrhosis. Although NASH is often found in patients with elevated alanine aminotransferase levels, even patients with normal ALT levels can have histologic features indicative of progressive disease. Should patients with normal ALT levels still undergo liver biopsies?

To answer this question, investigators retrospectively studied 458 consecutive NAFLD patients who underwent liver biopsies at four liver centers in Italy. Liver enzyme levels were normal in 63 of these patients, al…