NAFLD: utility of a lower cutpoint of ALT levels
There are a few new studies on non-alcoholic fatty liver disease (NAFLD) that challenge/illuminate some clinical issues in our conception of NAFLD and the approach to the disease. The current blog is from a French study that found that “normal” ALT levels with a cutpoint of >40 IU/L were insufficient in diagnosing NAFLD (see NAFLD NASH in DM with nl ALT DiabCare2023 in dropbox, or doi.org/10.2337/dc22-2048). The second (to follow soon) reviews the relatively common issue of NAFLD in “lean” individuals, who may well have a worse prognosis. Details : -- 713 patients with diabetes and NAFLD documented by ultrasound who had been referred to a hepatologist for further workup by FIB-4 and VCTE (vibration-controlled transient elastography) -- all participants were asked to get a liver biopsy if their ALT levels were persistently >20 IU/L in females or >30 IU/L in males, and with no other evident cause of liver disease -- 63% male, BMI 32, waist ci...